MEDICARE: MR. MICHAEL EKDAHL LPE-I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	95-03EI	AR

General Provider Information

NPI Number	:	1013020494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL EKDAHL LPE-I

Provider Business Mailing Address
First Line	:	P.O. BOX 251970
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72225-1970
Country	:	US
Telephone Number	:	501-666-8686
Fax Number	:	501-660-6830

Provider Business Practice Location Address
First Line	:	5800 WEST 10TH STREET
Second Line	:	SUITE 600
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-1761
Country	:	US
Telephone Number	:	501-660-6817
Fax Number	:	501-660-6825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	09/18/2023

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