Organization
FULFILLED LIFE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARDO PATRICK GLOVER LPC (CEO)
(870) 718-6199
Entity
Organization
Contact information
Practice address
1218 STONE ST STE 204, JONESBORO, AR 72401-4568
(901) 501-6091
(870) 466-4982
Mailing address
4609 SUMMIT RIDGE DR, JONESBORO, AR 72404-9101
(870) 718-6199
(870) 466-4982
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093088031
QUALCHOICE
AR
Enumeration date
04/17/2019
Last updated
04/17/2019
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