Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 16-13P | AR |
NPI | 1003369950 |
---|---|
Provider Name | Mrs. Cariann M Bergner-Moore |
First Address | Conway, AR 72034-3807 |
Second Address | Conway, AR 72034-3807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2016 |
Last Update Date | 28/07/2016 |