| NPI | 1235542150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN MICHELLE HENDRIX Office Coordinator 870-203-6085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AR 11-05P) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AR 11-05P) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2014-06-09 |