Healthcare Provider Details

I. General information

NPI: 1871541359
Provider Name (Legal Business Name): MARCELA VELARDE JOHNSTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 WILDWOOD AVENUE STE 140
SHERWOOD AR
72120-5088
US

IV. Provider business mailing address

2402 WILDWOOD AVENUE STE 140
SHERWOOD AR
72120-5088
US

V. Phone/Fax

Practice location:
  • Phone: 501-771-4442
  • Fax: 501-992-0138
Mailing address:
  • Phone: 501-771-4442
  • Fax: 501-992-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number314P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: