MEDICARE: KAITLYNN ROSEANNE GARRETT LAC

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	101YM0800X	Mental Health Counselor	A2508004	AR

General Provider Information

NPI Number	:	1831076306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYNN ROSEANNE GARRETT LAC

Provider Business Mailing Address
First Line	:	1707 LINWOOD DR STE B
Second Line	:
City	:	PARAGOULD
State	:	AR
Zip	:	72450-5365
Country	:	US
Telephone Number	:	870-604-4455
Fax Number	:	888-977-2956

Provider Business Practice Location Address
First Line	:	1801 CENTRAL AVE STE B
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-6800
Country	:	US
Telephone Number	:	501-389-8100
Fax Number	:	888-977-2956

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

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	08/18/2025

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