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1706 E Joyce Blvd Suite 3 Fayetteville AR 72703-5238 | |
| (479) 442-9381 | |
| (479) 442-9396 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1706 E Joyce Blvd, Fayetteville, Arkansas |
| Authorized Official Name and Position | Diane P Back (OFFICE MANAGER) |
| Authorized Official Contact | 4794429381 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1706 E Joyce Blvd Suite 3 Fayetteville AR 72703 Ph: (479) 442-9381 | 1706 E Joyce Blvd Suite 3 Fayetteville AR 72703-5238 Ph: (479) 442-9381 |
| NPI Number | 1598864043 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 07/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598864043 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 78-18 P (Arkansas) | Primary |
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