Healthcare Provider Details

I. General information

NPI: 1275028193
Provider Name (Legal Business Name): JACQUELINE REESE-SMITH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE YVONNE REESE PHD

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

V. Phone/Fax

Practice location:
  • Phone: 913-735-3002
  • Fax:
Mailing address:
  • Phone: 913-735-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number39071
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2017042119
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: