MEDICARE: CARA HARTFIELD PHD LICENSED PSYCHOLOGIST PLC

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	103TC0700X	Clinical Psychologist	06-15P	AR

General Provider Information

NPI Number	:	1639407554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARA HARTFIELD PHD LICENSED PSYCHOLOGIST PLC

Provider Business Mailing Address
First Line	:	112 W CENTER ST
Second Line	:	SUITE 215
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-6073
Country	:	US
Telephone Number	:	479-409-2212
Fax Number	:	479-439-8550

Provider Business Practice Location Address
First Line	:	112 W CENTER ST
Second Line	:	SUITE 215
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-6073
Country	:	US
Telephone Number	:	479-409-2212
Fax Number	:	479-439-8550

Authorized Official
Title or Position	:	OWNER
Name	:	CARA ROSE HARTFIELD
Credential	:	PHD
Telephone Number	:	479-409-2212

Provider Enumeration Date	:	12/04/2009
Last Update Date	:	12/04/2009

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