Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 7825P | AR |
N | 103TC0700X | Clinical Psychologist | 7825P | AR |
N | 102L00000X | Psychologist | 7825P | AR |
N | 103T00000X | Psychologist | 7825P | AR |
N | 103TA0700X | Adult Development & Aging Psychologist | 7825P | AR |
NPI | 1073581468 |
---|---|
Provider Name | Dr. Gary T. Souheaver |
First Address | Little Rock, AR 72223-9193 |
Second Address | Little Rock, AR 72223-9193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 08/07/2007 |