MEDICARE: LEE ANN DUNLAP LCSW

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	1041C0700X	Clinical Social Worker	1741-C	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	229649	OTHER	COMPSYCH
2	171591	OTHER	MHN
3	559944000	OTHER	MAGELLAN

General Provider Information

NPI Number	:	1720007958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE ANN DUNLAP LCSW

Provider Business Mailing Address
First Line	:	2001 CLUB MANOR DR STE J
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-7417
Country	:	US
Telephone Number	:	501-687-0488
Fax Number	:	501-687-0489

Provider Business Practice Location Address
First Line	:	2001 CLUB MANOR DR STE J
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-7417
Country	:	US
Telephone Number	:	501-687-0488
Fax Number	:	501-687-0489

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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