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General NPI Number Information
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NPI Number | 1932281193
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Entity Type | Organization
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Legal Business Name | ROBERT L SPRAY JR PHD PA
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 3104 S 70TH ST SUITE #103
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City | FORT SMITH
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State | AR
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Zip | 72903-5018
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Country | US
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Telephone | 479-452-1658
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Fax | 479-452-3865
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Provider Business Mailing Address
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Address Line | PO BOX 10105
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City | FORT SMITH
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State | AR
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Zip | 72917-0105
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Country | US
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Telephone | 479-452-1658
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Fax | 479-452-3865
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT L. SPRAY JR.
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Credential | PH.D.
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Telephone | 479-452-1658
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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 | 75-18P
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License Number State | AR
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