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General NPI Number Information
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NPI Number | 1881894806
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Entity Type | Individual
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Provider Name | TRACIE L. PASOLD PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 800 MARSHALL ST # 512-9 DEPT. OF PEDIATRICS, SECTION OF ADOLESCENT MEDICINE
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City | LITTLE ROCK
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State | AR
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Zip | 72202-3510
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Country | US
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Telephone | 501-364-1849
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Fax | 501-364-6728
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Provider Business Mailing Address
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Address Line | 800 MARSHALL ST # 512-9 DEPT. OF PEDIATRICS, SECTION OF ADOLESCENT MEDICINE
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City | LITTLE ROCK
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State | AR
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Zip | 72202-3510
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Country | US
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Telephone | 501-364-1849
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Fax | 501-364-6728
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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 | 07-24P
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License Number State | AR
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