Provider Demographics
NPI:1851957625
Name:AFFINITY RELATIONSHIP COACHING INC
Entity Type:Organization
Organization Name:AFFINITY RELATIONSHIP COACHING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:870-206-4377
Mailing Address - Street 1:175 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-2028
Mailing Address - Country:US
Mailing Address - Phone:870-206-4377
Mailing Address - Fax:870-324-5121
Practice Address - Street 1:280 W COURT ST
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2640
Practice Address - Country:US
Practice Address - Phone:870-450-0805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health