Provider Demographics
NPI:1457980799
Name:DAUNTLESS PSYCHIATRY
Entity Type:Organization
Organization Name:DAUNTLESS PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE-HALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-305-7201
Mailing Address - Street 1:2580 E JOYCE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3924
Mailing Address - Country:US
Mailing Address - Phone:479-305-7201
Mailing Address - Fax:479-900-9930
Practice Address - Street 1:2580 E JOYCE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3924
Practice Address - Country:US
Practice Address - Phone:479-305-7201
Practice Address - Fax:949-577-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty