Provider Demographics
NPI:1982139770
Name:FAIR WAY COUNSELING, PLLC
Entity Type:Organization
Organization Name:FAIR WAY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CRC
Authorized Official - Phone:800-709-0309
Mailing Address - Street 1:1215 MILITARY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2937
Mailing Address - Country:US
Mailing Address - Phone:800-709-0309
Mailing Address - Fax:866-545-5491
Practice Address - Street 1:1215 MILITARY RD STE 2
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2937
Practice Address - Country:US
Practice Address - Phone:800-709-0309
Practice Address - Fax:866-545-5491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-29
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2016-057251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336259316OtherNPI