MEDICARE: VELMA LOUISE BALTIMORE PH.D

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	106H00000X	Marriage & Family Therapist	P8102	AR

General Provider Information

NPI Number	:	1114145919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VELMA LOUISE BALTIMORE PH.D

Provider Business Mailing Address
First Line	:	2106 BROWN STREET
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204
Country	:	US
Telephone Number	:	501-663-1873
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 BROWN ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-4158
Country	:	US
Telephone Number	:	501-663-1873
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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