Provider Demographics
NPI:1053146092
Name:BELLA VISTA COUNSELING
Entity type:Organization
Organization Name:BELLA VISTA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-721-3835
Mailing Address - Street 1:1801 FOREST HILLS BLVD STE 121
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-3070
Mailing Address - Country:US
Mailing Address - Phone:479-721-3835
Mailing Address - Fax:
Practice Address - Street 1:1801 FOREST HILLS BLVD STE 121
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3070
Practice Address - Country:US
Practice Address - Phone:479-721-3835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty