Provider Demographics
NPI:1265950034
Name:CHAISSON, ELIZABETH (PHD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CHAISSON
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 1:4170 N HILLSIDE TER
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4824
Mailing Address - Country:US
Mailing Address - Phone:479-422-5712
Mailing Address - Fax:
Practice Address - Street 1:31 E CENTER ST STE 211
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5391
Practice Address - Country:US
Practice Address - Phone:479-422-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15-03103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical