MEDICARE: THE CENTER FOR CHILD AND FAMILY THERAPY

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	101YM0800X	Mental Health Counselor	P0704017	AR

General Provider Information

NPI Number	:	1265831200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR CHILD AND FAMILY THERAPY

Provider Business Mailing Address
First Line	:	3723 GRACEFUL OAKS DR
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-2028
Country	:	US
Telephone Number	:	501-844-0391
Fax Number	:

Provider Business Practice Location Address
First Line	:	11215 HERMITAGE RD STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3864
Country	:	US
Telephone Number	:	501-844-0394
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. CHERYE RENEE LIMOGES
Credential	:	LPC
Telephone Number	:	501-844-0394

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	08/19/2014

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