Active NPI
Mary Moore Ekdahl, PHD
- Clinical Psychologist
- North Little Rock, AR
National Provider Identifier
1710935218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 964P
- Practice address
- 4004 McCain Blvd
Suite 203
North Little Rock, AR 72116-8057 - Phone
- (501) 812-4268
- Fax
- (501) 812-4286
- NPI assigned
- May 5, 2006
- Last updated
- Mar 8, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 964P | AR | Primary |
Addresses
Primary practice location
4004 McCain Blvd
Suite 203
North Little Rock, AR 72116-8057
Mailing address
4004 McCain Blvd
Suite 203
North Little Rock, AR 72116-8057
Phone (501) 812-4268
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 139320719 | Medicaid | AR |
Other names 1
- Mary Catherine Moore
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 964P | AR | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Behavior Management Systems, Inc | Clinical | Past | Accepting new patients |
| Armo Diagnostics LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Medical Laboratory
- Sherwood, AR
- NPI 1790370583
-
- Clinical Psychologist
- Sherwood, AR
- NPI 1265454227
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362700800000",
"number": "1710935218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4004 MCCAIN BLVD",
"address_2": "SUITE 203",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721168057",
"telephone_number": "501-812-4268",
"fax_number": "501-812-4286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4004 MCCAIN BLVD",
"address_2": "SUITE 203",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721168057",
"telephone_number": "501-812-4268",
"fax_number": "501-812-4286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EKDAHL",
"first_name": "MARY",
"middle_name": "MOORE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-05",
"last_updated": "2013-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AR",
"license": "964P",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "139320719",
"state": "AR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "MOORE",
"middle_name": "CATHERINE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in North Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.