MEDICARE: DR. LAVERNE BELL-TOLLIVER PHD., LCSW, RPT-S

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	1041C0700X	Clinical Social Worker	1926C	AR

General Provider Information

NPI Number	:	1366164832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAVERNE BELL-TOLLIVER PHD., LCSW, RPT-S

Provider Business Mailing Address
First Line	:	P.O. BOX 45342
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72214
Country	:	US
Telephone Number	:	870-816-5169
Fax Number	:	501-374-1458

Provider Business Practice Location Address
First Line	:	425 W. BROADWAY, SUITE J
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114
Country	:	US
Telephone Number	:	501-374-5408
Fax Number	:	501-374-1458

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

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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