MEDICARE: JEREMY CURTIS LCSW

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	101Y00000X	Counselor
2	101Y00000X	Counselor	7956-C	AR

General Provider Information

NPI Number	:	1457646481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY CURTIS LCSW

Provider Business Mailing Address
First Line	:	3805 MCCAIN PARK DR STE 116
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7813
Country	:	US
Telephone Number	:	501-200-1556
Fax Number	:	501-200-1914

Provider Business Practice Location Address
First Line	:	3805 MCCAIN PARK DR STE 117
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7813
Country	:	US
Telephone Number	:	501-200-1556
Fax Number	:	501-200-1914

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

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	09/22/2021

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