Provider Demographics
NPI:1841321106
Name:STANFORD, ROYCE ALLAN III
Entity type:Individual
Prefix:MR
First Name:ROYCE
Middle Name:ALLAN
Last Name:STANFORD
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 BRECKENRIDGE DR STE 107
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1565
Mailing Address - Country:US
Mailing Address - Phone:501-681-7165
Mailing Address - Fax:
Practice Address - Street 1:1225 BRECKENRIDGE DR STE 107
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-551-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF1710013101YM0800X
ARA1710299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health