Healthcare Provider Details

I. General information

NPI: 1285836130
Provider Name (Legal Business Name): MARY JO MCLIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 SHUFFIELD DR
LITTLE ROCK AR
72205-7100
US

IV. Provider business mailing address

3516 RIDGE RD
NORTH LITTLE ROCK AR
72116-8757
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-9300
  • Fax:
Mailing address:
  • Phone: 501-812-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number98-8P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: