MEDICARE: DR. WILLIAM E SPAINE PSY.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	103TC0700X	Clinical Psychologist	99-10P	AR

General Provider Information

NPI Number	:	1225064066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM E SPAINE PSY.D.

Provider Business Mailing Address
First Line	:	225 N EAST AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-5226
Country	:	US
Telephone Number	:	479-442-8900
Fax Number	:	479-442-8901

Provider Business Practice Location Address
First Line	:	225 N EAST AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-5226
Country	:	US
Telephone Number	:	479-442-8900
Fax Number	:	479-442-8901

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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