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NPI Code Detail

MEDICARE: NORTHWEST COUNSELING & SOCIAL WORK SERVICES, INC

MEDICARE: NORTHWEST COUNSELING & SOCIAL WORK SERVICES, INC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)P931103AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15F449OTHERARBLUE SHIELD

General Provider Information

NPI Number : 1104882547
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST COUNSELING & SOCIAL WORK SERVICES, INC
Provider Business Mailing Address
First Line : PO BOX 264
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72702-0264
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 111 E DAVIDSON ST
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72701-3413
Country : US
Telephone Number : 479-973-9790
Fax Number : 479-973-9790
Authorized Official
Title or Position : OWNER/THERAPIST
Name : MRS. CATHERINE A TOTTEN
Credential : LCSW
Telephone Number : 479-973-9790
Provider Enumeration Date : 04/25/2006
Last Update Date : 08/06/2008

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