Healthcare Provider Details

I. General information

NPI: 1770572935
Provider Name (Legal Business Name): AVRAM ZOLTEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SHACKLEFORD PLZ STE 201
LITTLE ROCK AR
72211-1853
US

IV. Provider business mailing address

8 SHACKLEFORD PLZ STE 201
LITTLE ROCK AR
72211-1853
US

V. Phone/Fax

Practice location:
  • Phone: 501-218-8999
  • Fax: 501-219-8544
Mailing address:
  • Phone: 501-218-8999
  • Fax: 501-219-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number92-17P
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number92-17P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: