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General NPI Number Information
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NPI Number | 1033293733
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Entity Type | Organization
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Legal Business Name | FAMILY PSYCHOLOGICAL CENTER
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 623 N WALNUT ST
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City | HARRISON
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State | AR
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Zip | 72601-3617
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Country | US
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Telephone | 870-743-6225
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Fax | 870-743-6006
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Provider Business Mailing Address
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Address Line | 623 N WALNUT ST
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City | HARRISON
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State | AR
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Zip | 72601-3617
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Country | US
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Telephone | 870-743-6225
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Fax | 870-743-6006
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Authorized Official
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Title or Position | DIRECTOR/CEO
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Name | DR. WILLIAM CHARLES NICHOLS
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Credential | PSY.D.
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Telephone | 870-743-6225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 00-12P
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License Number State | AR
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