Provider Demographics
NPI:1710501556
Name:LILLIES IN THE VALLEY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LILLIES IN THE VALLEY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FANNIE
Authorized Official - Middle Name:BEATRICE
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:501-553-5539
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902-1011
Mailing Address - Country:US
Mailing Address - Phone:501-553-5539
Mailing Address - Fax:
Practice Address - Street 1:104 SONNET ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4437
Practice Address - Country:US
Practice Address - Phone:501-553-5539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-06
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty