Individual
DR. DALE CORDES PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4300 W 7TH ST, 116T/LR, LITTLE ROCK, AR 72205-5446
(501) 257-6598
(501) 257-6602
Mailing address
17 SUMMERLAND CT, LITTLE ROCK, AR 72227-3846
(501) 225-5037
(501) 257-6602
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
84-11P
AR
103TC0700X
Clinical Psychologist
84-11P
AR
Other
Enumeration date
09/16/2006
Last updated
09/11/2025
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