MEDICARE: BRENDA WOOLEY LCSW 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1982392684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENDA WOOLEY LCSW LLC

Provider Business Mailing Address
First Line	:	104 HAWK VALLEY DR
Second Line	:
City	:	PARON
State	:	AR
Zip	:	72122-9709
Country	:	US
Telephone Number	:	870-820-7097
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 HAWK VALLEY DR
Second Line	:
City	:	PARON
State	:	AR
Zip	:	72122-9709
Country	:	US
Telephone Number	:	870-820-7097
Fax Number	:

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	MRS. BRENDA FAYE WOOLEY
Credential	:	LCSW
Telephone Number	:	501-326-8372

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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