Individual
STANLEY MICHAEL REST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2400 S 48TH ST, SPRINGDALE, AR 72762-6683
(479) 750-2020
(479) 750-8967
Mailing address
PO BOX 6430, SPRINGDALE, AR 72766-6430
(479) 750-2020
(479) 750-1739
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
31-94P
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5S864
BLUE SHIELD PROVIDER #
AR
Enumeration date
06/30/2006
Last updated
02/21/2014
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