Provider Demographics
NPI:1073815502
Name:BELL, JASON ROBERT (MS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:BELL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 SILVER MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5658
Mailing Address - Country:US
Mailing Address - Phone:501-352-9750
Mailing Address - Fax:
Practice Address - Street 1:2518 SILVER MAPLE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-5658
Practice Address - Country:US
Practice Address - Phone:501-352-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR00-3E103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool