Healthcare Provider Details

I. General information

NPI: 1790143014
Provider Name (Legal Business Name): MICHAEL MCLAUGHLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N UNIVERSITY AVE SUITE 200
LITTLE ROCK AR
72207-6343
US

IV. Provider business mailing address

221 ASH ST
LITTLE ROCK AR
72205-4007
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-9300
  • Fax:
Mailing address:
  • Phone: 501-366-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR091771
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: