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Individual

DR. STEPHEN PRIOLEAU NICHOLS

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
204 N EAST AVE, FAYETTEVILLE, AR 72701-5225
(479) 442-0763
(479) 442-5587
Mailing address
204 N EAST AVE, FAYETTEVILLE, AR 72701-5225
(479) 442-0763
(479) 442-5587

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
79-36P
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
56343
BLUE CROSS BLUE SHIELD ID
AR
Enumeration date
01/17/2006
Last updated
07/09/2007
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