Healthcare Provider Details

I. General information

NPI: 1831302835
Provider Name (Legal Business Name): BEVERLY MASSEY FOTI L.P.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S PULASKI ST
LITTLE ROCK AR
72201-1925
US

IV. Provider business mailing address

11 ROCKY CREST CT
LITTLE ROCK AR
72211-5471
US

V. Phone/Fax

Practice location:
  • Phone: 501-372-2970
  • Fax:
Mailing address:
  • Phone: 501-227-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number77-35E
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: