MEDICARE: BDUB COUNSELING

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

General Provider Information

NPI Number	:	1023889508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BDUB COUNSELING

Provider Business Mailing Address
First Line	:	3017 S 70TH ST STE FGH
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5049
Country	:	US
Telephone Number	:	479-222-6210
Fax Number	:	479-222-6895

Provider Business Practice Location Address
First Line	:	3017 S 70TH ST STE FGH
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5049
Country	:	US
Telephone Number	:	479-222-6210
Fax Number	:	479-222-6895

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLIAM BRADLEY WALKER
Credential	:	LPC, LMFT
Telephone Number	:	479-414-6240

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	01/12/2024

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