Provider Demographics
NPI:1356874945
Name:TREE OF LIFE COUNSELING & CONSULTING, LLC
Entity type:Organization
Organization Name:TREE OF LIFE COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR/ORGANIZER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERIDETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:870-587-7056
Mailing Address - Street 1:422 COUNTY ROAD 225
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72324-8760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:713 FALLS BLVD N
Practice Address - Street 2:SUITE A
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-2208
Practice Address - Country:US
Practice Address - Phone:870-587-7056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4510C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty