MEDICARE: HEALTHY COPING CENTER

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	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1295214369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY COPING CENTER

Provider Business Mailing Address
First Line	:	11215 HERMITAGE RD STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3864
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11215 HERMITAGE RD STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3864
Country	:	US
Telephone Number	:	501-554-6558
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	JENNIFER ROSE PATTERSON
Credential	:	LCSW, ACSW
Telephone Number	:	501-554-6558

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	08/09/2018

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Directions to “HEALTHY COPING CENTER ” Practice Location

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