Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | AR 82-15P | AR |
N | 103TC0700X | Clinical Psychologist | AR 82-15P | AR |
N | 103TB0200X | Cognitive & Behavioral Psychologist | AR 82-15P | AR |
N | 103G00000X | Clinical Psychologist | AR 82-15P | AR |
N | 103TC0700X | Clinical Psychologist | AR 82-15P | AR |
Y | 103TC1900X | Counseling Psychologist | AR 82-15P | AR |
N | 103TF0200X | Forensic Psychologist | AR 82-15P | AR |
NPI | 1154304665 |
---|---|
Provider Name | James R Moneypenny |
First Address | Little Rock, AR 72205-2453 |
Second Address | Little Rock, AR 72205-2453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 25/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105182719 | (05) | AR |
56310 | BLUE CROSS BLUE SHIELD (01) | AR |