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General NPI Number Information
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NPI Number | 1477844314
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Entity Type | Individual
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Provider Name | GLENN RYAN MESMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1210 WOLFE ST
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City | LITTLE ROCK
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State | AR
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Zip | 72202-4618
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Country | US
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Telephone | 501-364-5150
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Fax | 501-364-3966
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Provider Business Mailing Address
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Address Line | 4301 W MARKHAM ST #783
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-686-8000
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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 | 10-14 AP-PL
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 11-24P
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License Number State | AR
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