Basic Information
| Provider Information | |||||||||
| NPI: | 1306069687 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY COUNSELING & DIAGNOSTIC CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 66 | ||||||||
| Address2: | |||||||||
| City: | WYNNE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723960066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703388106 | ||||||||
| FaxNumber: | 8703383430 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 MCDONOUGH | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723422912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703388106 | ||||||||
| FaxNumber: | 8703383430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HEISLER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 18703388106 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 16665 | AR | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 16665 | AR | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 133N00000X | 16665 | AR | X | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist | 163W00000X | 16665 | AR | X | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 164W00000X | 16665 | AR | X | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse | 224Z00000X | 16665 | AR | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 225100000X | 16665 | AR | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225200000X | 16665 | AR | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225X00000X | 16665 | AR | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | 16665 | AR | X | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.