Provider Demographics
NPI:1689457160
Name:TRI LAKES COUNSELING PLLC
Entity Type:Organization
Organization Name:TRI LAKES COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-545-6420
Mailing Address - Street 1:117 PIPER ST STE J
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8263
Mailing Address - Country:US
Mailing Address - Phone:501-545-6420
Mailing Address - Fax:501-441-6948
Practice Address - Street 1:117 PIPER ST STE J
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8263
Practice Address - Country:US
Practice Address - Phone:501-545-6420
Practice Address - Fax:501-441-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty