MEDICARE: MRS. TARA ELIZABETH BOND MHPP

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	104100000X	Social Worker	7004-M	AR
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1588941439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA ELIZABETH BOND MHPP

Provider Business Mailing Address
First Line	:	1712 OKMULGEE CT
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-4527
Country	:	US
Telephone Number	:	501-681-7850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 OKMULGEE CT
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-4527
Country	:	US
Telephone Number	:	501-681-7850
Fax Number	:

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

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	09/03/2014

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