Provider Demographics
NPI:1366481780
Name:CLINICAL PSYCHOLOGY OF FORT SMITH, LLC
Entity Type:Organization
Organization Name:CLINICAL PSYCHOLOGY OF FORT SMITH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST, LLC/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:479-783-0445
Mailing Address - Street 1:3801 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3045
Mailing Address - Country:US
Mailing Address - Phone:479-783-0445
Mailing Address - Fax:479-782-5883
Practice Address - Street 1:3801 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3045
Practice Address - Country:US
Practice Address - Phone:479-783-0445
Practice Address - Fax:479-782-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B075Medicare ID - Type Unspecified