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NPI Code Detail

MEDICARE: JARROD ANDERSON M.S., LPC, LMFT

MEDICARE: JARROD ANDERSON M.S., LPC, LMFT
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
1106H00000XMarriage & Family Therapist1805010AR
2101YP2500XProfessional CounselorP1805062AR

General Provider Information

NPI Number : 1093207615
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARROD ANDERSON M.S., LPC, LMFT
Provider Business Mailing Address
First Line : 12694 MILLER CHURCH RD
Second Line :
City : BENTONVILLE
State : AR
Zip : 72712-9041
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2105 S 54TH ST STE 2
Second Line :
City : ROGERS
State : AR
Zip : 72758-8191
Country : US
Telephone Number : 479-268-4557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2018
Last Update Date : 05/30/2018

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