Provider Demographics
NPI:1790082311
Name:PROFESSIONAL COUNSELING SERVICES OF MAGNOLIA
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING SERVICES OF MAGNOLIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:870-235-1112
Mailing Address - Street 1:1327 N WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2067
Mailing Address - Country:US
Mailing Address - Phone:870-235-1112
Mailing Address - Fax:870-235-1114
Practice Address - Street 1:1327 N WASHINGTON
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2067
Practice Address - Country:US
Practice Address - Phone:870-235-1112
Practice Address - Fax:870-235-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR218949578251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health