Provider Demographics
NPI:1740550177
Name:DEAN, BRANDY MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:MICHELLE
Last Name:DEAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 LONGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CAMMACK VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72207-2720
Mailing Address - Country:US
Mailing Address - Phone:501-951-1169
Mailing Address - Fax:
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-3467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR#11-18P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist