Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 13-23E | AR |
NPI | 1124440888 |
---|---|
Provider Name | Mary Bryant |
First Address | Jonesboro, AR 72401-4520 |
Second Address | Jonesboro, AR 72401-4520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2014 |
Last Update Date | 03/09/2014 |