MEDICARE: EMILY ANN STARR

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	101Y00000X	Counselor	A1509119	AR
2	101YM0800X	Mental Health Counselor	P1710370	AR
3	101Y00000X	Counselor	P1710370	AR

General Provider Information

NPI Number	:	1780835843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANN STARR

Provider Business Mailing Address
First Line	:	4101 S 89TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6319
Country	:	US
Telephone Number	:	479-739-3794
Fax Number	:

Provider Business Practice Location Address
First Line	:	4034 ROGERS AVE STE B
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3062
Country	:	US
Telephone Number	:	479-689-7009
Fax Number	:

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	05/17/2023

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Directions to “ EMILY ANN STARR ” Practice Location

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