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General NPI Number Information
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NPI Number | 1609919612
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Entity Type | Individual
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Provider Name | JEROME GLYNN DIE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 5 SAINT VINCENT CIR SUITE 302
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5412
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Country | US
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Telephone | 501-666-5242
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Fax | 501-666-2430
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Provider Business Mailing Address
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Address Line | 5 SAINT VINCENT CIR SUITE 302
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5412
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Country | US
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Telephone | 501-666-5242
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Fax | 501-666-2430
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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 | 92-25P
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 21056
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License Number State | TX
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