Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 77-57E | AR |
NPI | 1104023100 |
---|---|
Provider Name | Mr. James (jim) Hood Mcdonald |
First Address | Benton, AR 72015-7276 |
Second Address | Hot Springs, AR 71901-4195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 08/07/2007 |