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General NPI Number Information
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NPI Number | 1316470735
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Entity Type | Organization
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Legal Business Name | ELIZABETH CHAISSON, PHD, LLC
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 1 W MOUNTAIN ST SUITE 307
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-6068
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Country | US
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Telephone | 479-422-5712
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Fax |
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Provider Business Mailing Address
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Address Line | 1 W MOUNTAIN ST SUITE 307
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-6068
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Country | US
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Telephone | 479-422-5712
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ELIZABETH CHAISSON
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Credential | PHD
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Telephone | 479-422-5712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | AR-PL 15-03P
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License Number State | AR
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