Basic Information
| Provider Information | |||||||||
| NPI: | 1528454139 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONWAY COUNSELING & PSYCHOLOGICAL SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1312 DONAGHEY AVE | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720343807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013663600 | ||||||||
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| Address1: | 1312 DONAGHEY AVE | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720343807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013663600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2015 | ||||||||
| LastUpdateDate: | 04/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | KELLYBREW-MILLER | ||||||||
| AuthorizedOfficialFirstName: | AYISHA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5013363600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P0409039 | AR | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.