Individual
JAMIE SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4101 ANGELUS ST, PARAGOULD, AR 72450-2523
(870) 568-5195
Mailing address
607 BLUFF DR, POCAHONTAS, AR 72455-3281
(870) 393-8103
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236430795
—
AR
01
—
RBT-20-127397
BACB
—
Enumeration date
12/13/2019
Last updated
01/23/2023
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