MEDICARE: MRS. PEYTON RAE WOODRUFF LPC

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	101YP2500X	Professional Counselor	A1902019	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2109010	OTHER	AR	ARKANSAS BOARD OF EXAMINERS IN COUNSELING

General Provider Information

NPI Number	:	1225691058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PEYTON RAE WOODRUFF LPC

Provider Business Mailing Address
First Line	:	11215 HERMITAGE RD STE 204
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3864
Country	:	US
Telephone Number	:	501-777-5969
Fax Number	:

Provider Business Practice Location Address
First Line	:	11215 HERMITAGE RD STE 204
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3864
Country	:	US
Telephone Number	:	501-777-5969
Fax Number	:

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

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	06/14/2024

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