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NPI Code Detail

MEDICARE: MS. MICHELLE AINSWORTH LAC

MEDICARE: MS. MICHELLE AINSWORTH LAC
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
1171M00000XCase Manager/Care Coordinator
2101Y00000XCounselorA0910109AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851420764
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE AINSWORTH LAC
Provider Business Mailing Address
First Line : 125 DONS WAY
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71913-6478
Country : US
Telephone Number : 501-624-7111
Fax Number : 501-620-5109
Provider Business Practice Location Address
First Line : 1615 MLK BLVD
Second Line :
City : MALVERN
State : AR
Zip : 72104-2233
Country : US
Telephone Number : 501-332-5236
Fax Number : 501-620-5109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 12/11/2010

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Directions to “ MS. MICHELLE AINSWORTH LAC” Practice Location

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