Provider Demographics
NPI:1700821998
Name:JOHN N MARR PHD PA
Entity Type:Organization
Organization Name:JOHN N MARR PHD PA
Other - Org Name:BEHAVIOR THERAPY COUNSELING CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-575-0868
Mailing Address - Street 1:7 COLT SQUARE DR
Mailing Address - Street 2:#1
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-575-0868
Mailing Address - Fax:479-444-9346
Practice Address - Street 1:7 COLT SQUARE DR
Practice Address - Street 2:#1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-575-0868
Practice Address - Fax:479-444-9346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR=========Medicare UPIN