Healthcare Provider Details

I. General information

NPI: 1720307903
Provider Name (Legal Business Name): YOUSEF ARFAN FAHOUM DRPH, MA, LPE-I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 WILDWOOD AVE STE 200
SHERWOOD AR
72120
US

IV. Provider business mailing address

PO BOX 241967
LITTLE ROCK AR
72223-0037
US

V. Phone/Fax

Practice location:
  • Phone: 501-238-6560
  • Fax: 501-904-4452
Mailing address:
  • Phone: 501-238-6560
  • Fax: 501-904-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12-01E
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number12-01E
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number12-01E
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number12-01E
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number12-01E
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number12-01E
License Number StateAR
# 7
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number12-01E
License Number StateAR
# 8
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number12-01E
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: