Provider Demographics
NPI:1003661869
Name:MISSION PSYCHOTHERAPY SERVICES
Entity type:Organization
Organization Name:MISSION PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-551-3669
Mailing Address - Street 1:48 CARDINAL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-1686
Mailing Address - Country:US
Mailing Address - Phone:501-672-5341
Mailing Address - Fax:
Practice Address - Street 1:217 W 2ND ST STE 110
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2520
Practice Address - Country:US
Practice Address - Phone:501-672-5341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty