Provider Demographics
NPI:1275633299
Name:BELLANDO, JAYNE (PHD)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:BELLANDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MARSHALL ST
Mailing Address - Street 2:ACH #653
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3510
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-526-6562
Practice Address - Street 1:800 MARSHALL ST
Practice Address - Street 2:ACH #653
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3510
Practice Address - Country:US
Practice Address - Phone:501-364-1100
Practice Address - Fax:501-526-6562
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-12P103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0612POtherTRICARE
AR06070015000OtherQUALCHOICE
ARP00406675OtherRAILROAD MEDICARE
AR06070015000OtherQUALCHOICE