MEDICARE: HEALING TREE, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	P1410079	AR

General Provider Information

NPI Number	:	1952800807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING TREE, LLC

Provider Business Mailing Address
First Line	:	3007 CARRINGTON POINTE RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5693
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 S WALDRON RD STE C
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2681
Country	:	US
Telephone Number	:	479-883-2223
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELANIE TAYLOR
Credential	:	LPC, RPT
Telephone Number	:	479-883-2223

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	02/06/2018

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