Provider Demographics
NPI:1053874818
Name:THE STORIE HOUSE LLC
Entity type:Organization
Organization Name:THE STORIE HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:STORIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-208-9555
Mailing Address - Street 1:4019 MASSARD RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6221
Mailing Address - Country:US
Mailing Address - Phone:918-208-9555
Mailing Address - Fax:479-646-7977
Practice Address - Street 1:4019 MASSARD RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6221
Practice Address - Country:US
Practice Address - Phone:918-208-9555
Practice Address - Fax:479-646-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty