Provider Demographics
NPI:1780950683
Name:BACK TO BASICS COUNSELING SERVICES
Entity type:Organization
Organization Name:BACK TO BASICS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILA
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:DEBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-719-7051
Mailing Address - Street 1:5410 FREE FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903
Mailing Address - Country:US
Mailing Address - Phone:479-719-7051
Mailing Address - Fax:479-242-2653
Practice Address - Street 1:4943 OLD GREENWOOD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-719-7051
Practice Address - Fax:478-242-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2158-C251S00000X
AR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health