Provider Demographics
NPI:1740636968
Name:MOUROT, JON ETIENNE (PHD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:ETIENNE
Last Name:MOUROT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 KAVANAUGH BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3990
Mailing Address - Country:US
Mailing Address - Phone:501-663-8990
Mailing Address - Fax:
Practice Address - Street 1:2601 KAVANAUGH BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3990
Practice Address - Country:US
Practice Address - Phone:501-663-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist