MEDICARE: JODY LITTLE 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	22792	AZ

General Provider Information

NPI Number	:	1649645086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY LITTLE LPC

Provider Business Mailing Address
First Line	:	5500 W JADE ROCK PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-8306
Country	:	US
Telephone Number	:	520-233-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 N CENTRAL AVE FL 18
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-2322
Country	:	US
Telephone Number	:	646-941-7645
Fax Number	:

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

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	02/13/2024

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