Provider Demographics
NPI:1134468895
Name:ANDERSON, BRIAN (PSYD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:ANDERSON
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 1:218 N MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3120
Mailing Address - Country:US
Mailing Address - Phone:501-615-8838
Mailing Address - Fax:425-660-3207
Practice Address - Street 1:218 N MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3120
Practice Address - Country:US
Practice Address - Phone:501-615-8838
Practice Address - Fax:425-660-3207
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16-25P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical