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General NPI Number Information
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NPI Number | 1750590733
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Entity Type | Individual
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Provider Name | PATRENA D TABRON B.A, M.H.P.P.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 4400 SHUFFIELD DR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7100
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Country | US
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Telephone | 501-686-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 6800 MABELVALE CUT OFF
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City | LITTLE ROCK
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State | AR
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Zip | 72209-2370
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Country | US
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Telephone | 501-837-3728
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A1603032
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License Number State | AR
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