Healthcare Provider Details

I. General information

NPI: 1386676583
Provider Name (Legal Business Name): SAVANNA CLOER MCCAIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19903 SANTA ROSA DR
SPRINGDALE AR
72764-9297
US

IV. Provider business mailing address

19903 SANTA ROSA DR
SPRINGDALE AR
72764-9297
US

V. Phone/Fax

Practice location:
  • Phone: 479-856-6688
  • Fax: 479-856-6696
Mailing address:
  • Phone: 479-856-6688
  • Fax: 479-856-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00-11P
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number00-11P
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00-11P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: