MEDICARE: ERIKA BOSOLD LPC

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	171M00000X	Case Manager/Care Coordinator
2	101YP2500X	Professional Counselor
3	101YM0800X	Mental Health Counselor	A1912186	AR

General Provider Information

NPI Number	:	1568883023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA BOSOLD LPC

Provider Business Mailing Address
First Line	:	1409 S GREENWICH AVE
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-6992
Country	:	US
Telephone Number	:	870-878-2294
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 S ROGERS ST STE G
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-4331
Country	:	US
Telephone Number	:	479-335-5747
Fax Number	:	479-957-9083

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

Provider Enumeration Date	:	12/30/2013
Last Update Date	:	06/16/2023

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Directions to “ ERIKA BOSOLD LPC” Practice Location

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