MEDICARE: KATHERINE ELFRIDA SEIDL LMSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1597	AR
2	1041C0700X	Clinical Social Worker	1032-M	AR

General Provider Information

NPI Number	:	1215320544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ELFRIDA SEIDL LMSW

Provider Business Mailing Address
First Line	:	1011 WHISPERING PINE RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-5422
Country	:	US
Telephone Number	:	501-231-0353
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 WHISPERING PINE RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-5422
Country	:	US
Telephone Number	:	501-231-0353
Fax Number	:

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

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	04/17/2024

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