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General NPI Number Information
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NPI Number | 1083186274
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Entity Type | Individual
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Provider Name | CHANCE HOLLIS MCDERMOTT PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 415 N MCKINLEY ST STE 500
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3018
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Country | US
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Telephone | 501-664-6632
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Fax |
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Provider Business Mailing Address
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Address Line | 1421 N UNIVERSITY AVE APT N331
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City | LITTLE ROCK
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State | AR
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Zip | 72207-5249
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Country | US
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Telephone | 540-246-8454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 18-34AP-PL
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License Number State | AR
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