MEDICARE: CATHERINE L COON L.P., R.P.T.

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	101Y00000X	Counselor	06-09E	AR
2	103T00000X	Psychologist	08-17P	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1093722415	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1093722415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE L COON L.P., R.P.T.

Provider Business Mailing Address
First Line	:	1208 RICHARD ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-5621
Country	:	US
Telephone Number	:	870-918-5989
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 RICHARD ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-5621
Country	:	US
Telephone Number	:	870-918-5989
Fax Number	:

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	05/02/2011

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