Healthcare Provider Details

I. General information

NPI: 1639361165
Provider Name (Legal Business Name): ADAM BENTON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 MCCAIN BLVD. SUITE 203
NORTH LITTLE ROCK AR
72116
US

IV. Provider business mailing address

4004 MCCAIN BLVD SUITE 203
NORTH LITTLE ROCK AR
72116-8057
US

V. Phone/Fax

Practice location:
  • Phone: 501-765-4136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: