Brian Anderson, PSY.D.
Individual provider Active NPI Clinical Psychologist · Little Rock, AR
NPI 1134468895 · NPPES record last updated Apr 15, 2024
Key facts
- NPI
- 1134468895
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 16-25P (AR)
- Practice address
- 218 N McKinley St
Little Rock, AR 72205-3120 - Phone
- (501) 615-8838
- Fax
- (425) 660-3207
- NPI assigned
- Jan 31, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
218 N McKinley St
Little Rock, AR 72205-3120
Phone (501) 615-8838
2502 Mount Moriah Rd
Suite A149
Memphis, TN 38115-1515
Phone (501) 615-8838
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR, TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180112000030 | AR | Practitioner - Clinical Psychologist | 0547542599 | Reassigns benefits to 4 organizations |
| I20190305003308 | TN | Practitioner - Clinical Psychologist | 0547542599 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16-25P | AR | MD | Clinical Psychologist |
| 3589 | TN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arkansas Heart Hospital Rural Health Services, LLC | Current |
Accepting new patients | |
| Arkansas Heart Hospital, LLC | Current |
Accepting new patients | |
| Arkansas Heart Hospital, LLC | Current |
Accepting new patients | |
| Integrated Psych Solutions Inc | Clinical | Current |
Accepting new patients |
| Cenfam | Clinical | Current |
Accepting new patients |
| Lead, Teach, Mentor LLC | Past | Accepting new patients |
Locations
1100 N University Ave
Ste 108
Little Rock, AR 72207
Phone (501) 351-1510
1100 N University Ave
Ste 139
Little Rock, AR 72207
Phone (501) 416-1019
7 Shackleford West Blvd
Little Rock, AR 72211
Phone (501) 614-3671
2502 Mount Moriah Rd
Ste A149
Memphis, TN 38115
Phone (501) 416-1019
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 16-25P | AR | Yes |
Addresses
Primary practice location
218 N McKinley St
Little Rock, AR 72205-3120
Mailing address
218 N McKinley St
Little Rock, AR 72205-3120
Phone (501) 615-8838
Other providers in Little Rock, AR
- Akivia Anderson
- Allison Marie Anderson
- Angela Margariette Anderson
- Anna Anderson
- Bob E. Anderson
- Brian Anderson
- Catina Anderson
- Erin M. U. Anderson
- Heaven Leigh Anderson
- James L Anderson
All providers in Little Rock, AR · Clinical Psychologist in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.