Provider Demographics
NPI:1245070762
Name:VINEYARD COUNSELING LLC
Entity type:Organization
Organization Name:VINEYARD COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-368-2911
Mailing Address - Street 1:13767 PELLA LN
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-8781
Mailing Address - Country:US
Mailing Address - Phone:479-368-2911
Mailing Address - Fax:479-391-5254
Practice Address - Street 1:2703 SE G ST STE 2
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3740
Practice Address - Country:US
Practice Address - Phone:479-368-2911
Practice Address - Fax:479-391-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty