Provider Demographics
NPI:1073888756
Name:MCDANIEL, JUDSON
Entity Type:Individual
Prefix:
First Name:JUDSON
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 W MARKHAM ST STE D5
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2290
Mailing Address - Country:US
Mailing Address - Phone:501-231-8472
Mailing Address - Fax:
Practice Address - Street 1:10515 W MARKHAM ST STE D5
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2290
Practice Address - Country:US
Practice Address - Phone:501-231-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health