Provider Demographics
NPI:1053187963
Name:ARK VALLEY COUNSELING & SUPERVISION SERVICES, LLC
Entity type:Organization
Organization Name:ARK VALLEY COUNSELING & SUPERVISION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYLAND
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-468-7697
Mailing Address - Street 1:24600 COUNTY ROAD 21
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-9765
Mailing Address - Country:US
Mailing Address - Phone:719-469-2670
Mailing Address - Fax:
Practice Address - Street 1:317 W 3RD ST STE 203
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1401
Practice Address - Country:US
Practice Address - Phone:719-469-2670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARK VALLEY COUNSELING & SUPERVISION SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty