Provider Demographics
NPI:1083186274
Name:MCDERMOTT, CHANCE HOLLIS (PSYD)
Entity Type:Individual
Prefix:
First Name:CHANCE
Middle Name:HOLLIS
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 N UNIVERSITY AVE APT N331
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5249
Mailing Address - Country:US
Mailing Address - Phone:540-246-8454
Mailing Address - Fax:
Practice Address - Street 1:415 N MCKINLEY ST STE 500
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3018
Practice Address - Country:US
Practice Address - Phone:501-664-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR18-34AP-PL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical