Provider Demographics
NPI:1609241454
Name:ROSE SMITH PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:ROSE SMITH PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:501-804-1786
Mailing Address - Street 1:2723 FOXCROFT RD
Mailing Address - Street 2:SUITE 311A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2455
Mailing Address - Country:US
Mailing Address - Phone:501-804-1786
Mailing Address - Fax:501-661-0304
Practice Address - Street 1:2723 FOXCROFT RD
Practice Address - Street 2:SUITE 311A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2455
Practice Address - Country:US
Practice Address - Phone:501-804-1786
Practice Address - Fax:501-661-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR13-03POtherSTATE LICENSE