Organization Active NPI

NW Arkansas Psychological Group Inc

  • Clinical Psychologist
  • Fayetteville, AR
National Provider Identifier
1598864043
Registry record updated Jul 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
78-18 P Issued in AR
Legal business name
NW ARKANSAS PSYCHOLOGICAL GROUP INC
Practice address
1706 E Joyce Blvd
Suite 3
Fayetteville, AR 72703-5238
Phone
(479) 442-9381
Fax
(479) 442-9396
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2008

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

Authorized official

Name
Mrs. Diane P Back, R.N.
Title
Office Manager
Phone
(479) 442-9381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 78-18 P AR Primary

Addresses

Primary practice location

1706 E Joyce Blvd
Suite 3
Fayetteville, AR 72703-5238

Mailing address

1706 E Joyce Blvd
Suite 3
Fayetteville, AR 72703
Phone (479) 442-9381

Other names 1

  • NORTHWEST AR PSYCHOLOGICAL GROUP Doing business as

National Provider Directory

National Provider Directory

Locations

1706 E Joyce Blvd
Ste 3
Fayetteville, AR 72703
Phone (479) 442-9381

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1598864043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 E JOYCE BLVD",
            "address_2": "SUITE 3",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-442-9381",
            "fax_number": "479-442-9396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 E JOYCE BLVD",
            "address_2": "SUITE 3",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035238",
            "telephone_number": "479-442-9381",
            "fax_number": "479-442-9396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NW ARKANSAS PSYCHOLOGICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "BACK",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "479-442-9381",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "AR",
            "license": "78-18 P",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHWEST AR PSYCHOLOGICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.