MEDICARE: MCCAIN PSYCHOTHERAPY CENTER

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	1041C0700X	Clinical Social Worker	1444C	AR
2	1041C0700X	Clinical Social Worker	697C	AR
3	163WP0808X	Psychiatric/Mental Health Registered Nurse	S01007	AR

General Provider Information

NPI Number	:	1992127419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCAIN PSYCHOTHERAPY CENTER

Provider Business Mailing Address
First Line	:	3805 MCCAIN PARK DR STE 116
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7813
Country	:	US
Telephone Number	:	501-758-9993
Fax Number	:

Provider Business Practice Location Address
First Line	:	3805 MCCAIN PARK DR STE 116
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7813
Country	:	US
Telephone Number	:	501-758-9993
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PEGGY G MORROW
Credential	:	APRN
Telephone Number	:	501-758-9993

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	01/17/2014

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1922355841 — KATIE MITCHELL WALKER LCSW
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NORTH LITTLE ROCK, AR
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1982055828 — MARGARET ANN TAYLOR LCSW
Practice Location Address:

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