Provider Demographics
NPI:1326255464
Name:BARRY S MCDONALD PHD PA
Entity Type:Organization
Organization Name:BARRY S MCDONALD PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:SEAMAN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:870-535-2513
Mailing Address - Street 1:1811 SO OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-6560
Mailing Address - Country:US
Mailing Address - Phone:870-535-2513
Mailing Address - Fax:
Practice Address - Street 1:1811 SO OLIVE ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-6560
Practice Address - Country:US
Practice Address - Phone:870-535-2513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8717P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145943744Medicaid
AR59301Medicare ID - Type Unspecified