Healthcare Provider Details

I. General information

NPI: 1831104363
Provider Name (Legal Business Name): ADAM BRAZAS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MEDICAL PLZ
MOUNTAIN HOME AR
72653-2919
US

IV. Provider business mailing address

PO BOX 1776
MOUNTAIN HOME AR
72654-1776
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-6901
  • Fax: 870-424-8703
Mailing address:
  • Phone: 870-425-6901
  • Fax: 870-424-8703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberP9008114
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: