Provider Demographics
NPI:1770572935
Name:ZOLTEN, AVRAM (PHD)
Entity type:Individual
Prefix:
First Name:AVRAM
Middle Name:
Last Name:ZOLTEN
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 1:8 SHACKLEFORD PLZ STE 201
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1853
Mailing Address - Country:US
Mailing Address - Phone:501-218-8999
Mailing Address - Fax:501-219-8544
Practice Address - Street 1:8 SHACKLEFORD PLZ STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1853
Practice Address - Country:US
Practice Address - Phone:501-218-8999
Practice Address - Fax:501-219-8544
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
AR92-17P103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR501750000001OtherQUALCHOICE
AR122248719Medicaid
AR122248719Medicaid