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General NPI Number Information
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NPI Number | 1548440514
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Entity Type | Individual
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Provider Name | JAMES LEE PRIDMORE LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 614 E EMMA AVE SUITE 300
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City | SPRINGDALE
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State | AR
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Zip | 72764-4634
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Country | US
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Telephone | 479-751-7417
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Fax | 479-751-4898
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Provider Business Mailing Address
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Address Line | 614 E EMMA AVE SUITE 300
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City | SPRINGDALE
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State | AR
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Zip | 72764-4634
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Country | US
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Telephone | 479-751-7417
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Fax | 479-751-4898
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5326-C
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License Number State | AR
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