MEDICARE: ALYSSA P PICKETT 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	104100000X	Social Worker	6919-C	AR

General Provider Information

NPI Number	:	1881033538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA P PICKETT LCSW

Provider Business Mailing Address
First Line	:	323 CENTER ST STE 1401
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-2605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 CENTER ST STE 1401
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-2605
Country	:	US
Telephone Number	:	430-200-8088
Fax Number	:

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

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	12/11/2019

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