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NPI Code Detail

MEDICARE: MRS. CYNTHIA ROSE CHARLESTON MHPP

MEDICARE: MRS. CYNTHIA ROSE CHARLESTON MHPP
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1598912974
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CYNTHIA ROSE CHARLESTON MHPP
Provider Business Mailing Address
First Line : 5537 BLEAUX AVE
Second Line :
City : SPRINGDALE
State : AR
Zip : 72762-0737
Country : US
Telephone Number : 479-872-5580
Fax Number : 479-872-5581
Provider Business Practice Location Address
First Line : 608 S HIGHWAY 65 82
Second Line : STE B
City : LAKE VILLAGE
State : AR
Zip : 71653-1743
Country : US
Telephone Number : 870-265-3711
Fax Number : 870-265-3707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2008
Last Update Date : 08/27/2008

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Directions to “ MRS. CYNTHIA ROSE CHARLESTON MHPP” Practice Location

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