Douglas M Sell, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

09-04P Issued in AR

Practice address

Arkansas Dept. of Correction
100 Walco Lane
Malvern, AR 72104

Phone

(501) 467-3485

NPI assigned

Nov 21, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• State of Arkansas

  • Psychiatric Hospital
  • Little Rock, AR
  • NPI 1891808630
  Medicare reassignment NPD
• State of Arkansas

  • Skilled Nursing Facility
  • North Little Rock, AR
  • NPI 1689117756
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1184260408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1630",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721041475",
            "telephone_number": "501-467-3485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ARKANSAS DEPT. OF CORRECTION",
            "address_2": "100 WALCO LANE",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "72104",
            "telephone_number": "501-467-3485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELL",
        "first_name": "DOUGLAS",
        "middle_name": "M",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-21",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AR",
            "license": "09-04P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS LICENSE NUMBER",
            "identifier": "09-04P",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trudy Scales-Fendley
• Carrie Anne Schoultz, LMT
• Heather Schultz
• Dailakeisha Scott
• Rachel Scrimshire, APRN
• Sera Triadic, PLLC
• Shane Higginbotham MD PA
• Shawn Purifoy, M.D., P.a.
• Markesia Sherman
• Amelia L Shinn

• Clinical Psychologist in Malvern, AR
• Providers in Malvern, AR by specialty
• Clinical Psychologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.