Individual
NICHOLAS MITRANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPE-I
Contact information
Practice address
4206 PRINCE STREET, CONWAY, AR 72034-9398
(501) 932-0255
Mailing address
4206 PRINCE STREET, CONWAY, AR 72034-9398
(501) 932-0255
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
18-22P
AR
103TC0700X
Clinical Psychologist
Primary
18-22P
AR
103TC1900X
Counseling Psychologist
18-22P
AR
103TC2200X
Clinical Child & Adolescent Psychologist
18-22P
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
232944719
—
AR
Enumeration date
05/31/2016
Last updated
07/24/2019
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