Lifebridge Ar Counseling

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P1402021 Issued in AR

Legal business name

LIFEBRIDGE AR COUNSELING

Practice address

301 East Ashley St.
Siloam Springs, AR 72761

Phone

(479) 790-2483

NPI assigned

Feb 20, 2015

Organization subpart

Yes

Parent organization

LIFEBRIDGE AR COUNSELINGAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ross Kelley, LPC

Title

Owner

Phone

(479) 790-2483

Specialties & licenses 1

Addresses

Part of

Lifebridge Ar Counseling

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424390400000",
    "number": "1508258021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 EAST ASHLEY ST.",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "72761",
            "telephone_number": "479-790-2483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 EAST ASHLEY ST.",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "72761",
            "telephone_number": "479-790-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE AR COUNSELING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFEBRIDGE AR COUNSELING",
        "enumeration_date": "2015-02-20",
        "last_updated": "2015-02-20",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-790-2483",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P1402021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Siloam Springs, AR
• Providers in Siloam Springs, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.