Provider Demographics
NPI:1699548131
Name:MYTHERAPY COUNSELING & LIFE COACHING SERVICES PLLC
Entity type:Organization
Organization Name:MYTHERAPY COUNSELING & LIFE COACHING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BILLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-402-0123
Mailing Address - Street 1:1201 MILITARY RD STE 2 #238
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015
Mailing Address - Country:US
Mailing Address - Phone:501-402-0123
Mailing Address - Fax:833-996-3534
Practice Address - Street 1:701 SOUTH ST STE 100
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4452
Practice Address - Country:US
Practice Address - Phone:501-402-0123
Practice Address - Fax:833-996-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health