MEDICARE: PLAYFUL PATH COUNSELING, LLC

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	1041C0700X	Clinical Social Worker	869-C	AR
2	101YP2500X	Professional Counselor	P0906036	AR

General Provider Information

NPI Number	:	1427419266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAYFUL PATH COUNSELING, LLC

Provider Business Mailing Address
First Line	:	4943 OLD GREENWOOD RD STE 8
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6923
Country	:	US
Telephone Number	:	479-274-8132
Fax Number	:	479-431-4430

Provider Business Practice Location Address
First Line	:	4943 OLD GREENWOOD RD STE 8
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6923
Country	:	US
Telephone Number	:	479-274-8132
Fax Number	:	479-431-4430

Authorized Official
Title or Position	:	OWNER
Name	:	ERICA HUTCHISON
Credential	:	LPC-S
Telephone Number	:	479-274-8132

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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