Organization
SHILOH'S COUNSELING AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON WALLER LPC (MANAGER)
(501) 547-3763
Entity
Organization
Contact information
Practice address
3634 CENTRAL AVE STE A, HOT SPRINGS, AR 71913-6472
(501) 547-3763
Mailing address
3634 CENTRAL AVE STE A, HOT SPRINGS, AR 71913-6472
(501) 547-3763
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P2108017
ARKANSAS BOARD OF EXAMINERS IN COUNSELING
AR
Enumeration date
10/26/2021
Last updated
10/26/2021
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