MEDICARE: NWA PREMIER COUNSELING

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1679955926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NWA PREMIER COUNSELING

Provider Business Mailing Address
First Line	:	5305 W VILLAGE PKWY STE 8
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8116
Country	:	US
Telephone Number	:	479-531-4057
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 W VILLAGE PKWY STE 8
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8116
Country	:	US
Telephone Number	:	479-531-4057
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST AND OWNER
Name	:	MS. TORIE SULLIVAN
Credential	:	M.S., LPC
Telephone Number	:	479-531-4057

Provider Enumeration Date	:	06/23/2015
Last Update Date	:	06/23/2015

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