Provider Demographics
NPI:1487361911
Name:CRESTVIEW PSYCHOLOGICAL TESTING AND COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:CRESTVIEW PSYCHOLOGICAL TESTING AND COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:417-310-2401
Mailing Address - Street 1:203 CASCADE CIR
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-5506
Mailing Address - Country:US
Mailing Address - Phone:417-310-2401
Mailing Address - Fax:
Practice Address - Street 1:3061 WAGON WHEEL RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0114
Practice Address - Country:US
Practice Address - Phone:417-310-2401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty