Organization
SUSAN L SHACKELFORD, PHD & ASSOCIATES, PA
Active
Other names
Psychology & Counseling Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAVONNA M LATTA (OFFICE MANAGER)
(479) 443-5575
Entity
Organization
Contact information
Practice address
1 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1825
(479) 443-5575
(479) 443-9554
Mailing address
1 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1825
(479) 443-5575
(479) 443-9554
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
97-04P
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5T520
BLUECROSS BLUESHIELD
AR
Enumeration date
02/08/2007
Last updated
04/14/2011
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