Provider Demographics
NPI:1679726533
Name:LAGORY, JASON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:LAGORY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHILDRENS WAY
Mailing Address - Street 2:SLOT 654
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-5150
Mailing Address - Fax:501-364-1592
Practice Address - Street 1:11 CHILDRENS WAY
Practice Address - Street 2:SLOT 654
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-5150
Practice Address - Fax:501-364-1592
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR10-18P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR170484795Medicaid
AR170484795Medicaid