MEDICARE: MS. ANDREA BYNUM 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker		AR

General Provider Information

NPI Number	:	1831439983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA BYNUM LCSW

Provider Business Mailing Address
First Line	:	PO BOX 22511
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72221-2511
Country	:	US
Telephone Number	:	501-960-8195
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 W CAPITOL AVE STE 1925
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3704
Country	:	US
Telephone Number	:	501-247-1461
Fax Number	:	501-480-5181

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

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	03/01/2024

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