MEDICARE: ERIC BASKINS LAC

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

General Provider Information

NPI Number	:	1336266055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC BASKINS LAC

Provider Business Mailing Address
First Line	:	PO BOX 251970
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72225-1970
Country	:	US
Telephone Number	:	501-666-8686
Fax Number	:	501-660-6830

Provider Business Practice Location Address
First Line	:	5509 FOREST PLACE
Second Line	:	SUITE 100
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207
Country	:	US
Telephone Number	:	501-666-4949
Fax Number	:	501-660-6840

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	10/07/2008

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