Provider Demographics
NPI:1225041205
Name:LIERLY, JOHN ALVIN JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALVIN
Last Name:LIERLY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4020 RICHARDS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2650
Mailing Address - Country:US
Mailing Address - Phone:501-753-1616
Mailing Address - Fax:501-753-8471
Practice Address - Street 1:4020 RICHARDS RD
Practice Address - Street 2:SUITE F
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2650
Practice Address - Country:US
Practice Address - Phone:501-753-1616
Practice Address - Fax:501-753-8471
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR75-23P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56283Medicare ID - Type Unspecified