MEDICARE: MR. ARTHUR WAYNE CHUPIK MSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	144	TX
2	101YP2500X	Professional Counselor	8921	TX
3	1041C0700X	Clinical Social Worker	2415-C	AR
4	106H00000X	Marriage & Family Therapist	0001000-000091	TX
5	101YM0800X	Mental Health Counselor	98422	TX

General Provider Information

NPI Number	:	1518016450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARTHUR WAYNE CHUPIK MSW

Provider Business Mailing Address
First Line	:	1715 PINE VALLEY RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-2605
Country	:	US
Telephone Number	:	254-368-9699
Fax Number	:	501-664-8546

Provider Business Practice Location Address
First Line	:	1715 PINE VALLEY RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-2605
Country	:	US
Telephone Number	:	254-368-9699
Fax Number	:	501-664-8546

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	01/12/2010

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