MEDICARE: CARISSA ALANA BONE LPC

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	P0405020	AR

General Provider Information

NPI Number	:	1427261254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA ALANA BONE LPC

Provider Business Mailing Address
First Line	:	3111 WOODRUFF CREEK DR
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-2678
Country	:	US
Telephone Number	:	501-952-8869
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 WOODRUFF CREEK DR
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-2678
Country	:	US
Telephone Number	:	501-952-8869
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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Directions to “ CARISSA ALANA BONE LPC” Practice Location

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