Organization
RIVERBASE COUNSELING CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDSEY FULTZ (MANAGER)
(479) 209-5557
Entity
Organization
Contact information
Practice address
2405 VILLA DR, OZARK, AR 72949-9452
(479) 214-4319
Mailing address
PO BOX 41, OZARK, AR 72949-0041
(479) 209-5557
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14028085
CAQH
AR
01
—
1790678894
NPI
AR
01
—
1861785578
NPI
AR
05
—
322059795
—
AR
05
—
342769744
—
AR
01
—
P1701221
LPC
AR
Enumeration date
05/29/2025
Last updated
01/23/2026
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