Provider Demographics
NPI:1851455505
Name:FRANK, JAMIE (PHD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:FRANK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 E MEADOW ST
Mailing Address - Street 2:STE 4
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5320
Mailing Address - Country:US
Mailing Address - Phone:479-310-0264
Mailing Address - Fax:888-633-0366
Practice Address - Street 1:26 E MEADOW ST
Practice Address - Street 2:STE 4
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5320
Practice Address - Country:US
Practice Address - Phone:479-310-0264
Practice Address - Fax:888-633-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16-23P103T00000X, 103TF0200X, 103TH0004X, 103TH0100X, 103TC0700X, 103TH0100X, 103TF0200X, 103TC2200X, 103TB0200X, 103TC1900X, 103TH0004X, 103TM1800X, 103TR0400X, 103T00000X
ARP1403037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR217670719Medicaid
AR217670719Medicaid