Provider Demographics
NPI:1508406372
Name:PSYCHOLOGY PARTNERS, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGY PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPE-I
Authorized Official - Phone:501-476-7600
Mailing Address - Street 1:8201 RANCH BLVD STE B1
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4617
Mailing Address - Country:US
Mailing Address - Phone:501-476-7600
Mailing Address - Fax:
Practice Address - Street 1:8201 RANCH BLVD STE B1
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4617
Practice Address - Country:US
Practice Address - Phone:501-425-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1538304175Medicaid