JAMES M FUENDELING, PHD & ASSOCIATES - NPI NUMBER 1992850606

Summary

Provider Name: JAMES M FUENDELING, PHD & ASSOCIATES

NPI Number: 1992850606

Clasification: Psychologist (103TC0700X)

Specialization: Clinical

Address:
840 N POLLARD AVE
FAYETTEVILLE, AR
ZIP 72701

Phone Number: (479) 422-4489



Detailed Information

JAMES M FUENDELING, PHD & ASSOCIATES is a clinical psychologist in Fayetteville, AR. The assigned NPI number for this provider is 1992850606 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

840 N POLLARD AVE
FAYETTEVILLE, AR
ZIP 72701
Phone: (479) 422-4489
Fax: (479) 444-6770

The provider's authorized official is James M Fuendeling .
The authorized official title is Office Manager and has the following contact phone number (479) 422-4489.

The enumeration date for this NPI number is 1/24/2007 and was last updated on 9/20/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 103TC0700X Psychologist Clinical 01-15P AR No
2 103TC1900X Psychologist Counseling 01-05P AR No
3 103G00000X Clinical Neuropsychologist 01-15P AR Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 BLUECROSS BLUESHIELD OTHER AR 5X899

NPI Record

No. Field Name Field Value
1 NPI 1992850606
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name JAMES M FUENDELING, PHD & ASSOCIATES
5 Provider First Line Business Practice Location Address 840 N POLLARD AVE
6 Provider Business Practice Location Address City Name FAYETTEVILLE
7 Provider Business Practice Location Address State Name AR
8 Provider Business Practice Location Address Postal Code 72701
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 4794224489
11 Provider Business Practice Location Address Fax Number 4794446770
12 Provider Enumeration Date 1/24/2007
13 Last Update Date 9/20/2012
14 Authorized Official Last Name FUENDELING
15 Authorized Official First Name JAMES
16 Authorized Official Middle Name M
17 Authorized Official Title or Position OFFICE MANAGER
18 Authorized Official Telephone Number 4794224489
19 Healthcare Provider Taxonomy Code 1 103TC0700X
20 Provider License Number 1 01-15P
21 Provider License Number State Code 1 AR
22 Healthcare Provider Primary Taxonomy Switch 1 N
23 Healthcare Provider Taxonomy Code 2 103TC1900X
24 Provider License Number 2 01-05P
25 Provider License Number State Code 2 AR
26 Healthcare Provider Primary Taxonomy Switch 2 N
27 Healthcare Provider Taxonomy Code 3 103G00000X
28 Provider License Number 3 01-15P
29 Provider License Number State Code 3 AR
30 Healthcare Provider Primary Taxonomy Switch 3 Y
31 Other Provider Identifier 1 BLUECROSS BLUESHIELD
32 Other Provider Identifier Type Code 1 01
33 Other Provider Identifier State 1 AR
34 Other Provider Identifier Issuer 1 5X899
35 Is Organization Subpart N
36 Authorized Official Name Prefix Text DR.
37 Authorized Official Credential Text PHD
38 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP
39 Healthcare Provider Taxonomy Group 2 193200000X MULTI-SPECIALTY GROUP
40 Healthcare Provider Taxonomy Group 3 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 3/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.