Provider Demographics
NPI:1902792641
Name:RESILIENT YOUTH COUNSELING LLC
Entity type:Organization
Organization Name:RESILIENT YOUTH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:
Authorized Official - First Name:AVANLEA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:501-908-5187
Mailing Address - Street 1:3101 S 99TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5346
Mailing Address - Country:US
Mailing Address - Phone:501-908-5187
Mailing Address - Fax:
Practice Address - Street 1:2408 S 51ST CT STE G
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3666
Practice Address - Country:US
Practice Address - Phone:479-323-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health