Basic Information
| Provider Information | |||||||||
| NPI: | 1467883348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRENT-WATSON | ||||||||
| FirstName: | SHARI | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 56050 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722156050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016610720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2239 S CARAWAY RD | ||||||||
| Address2: | SUITE M | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724016204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709103757 | ||||||||
| FaxNumber: | 8709104999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2013 | ||||||||
| LastUpdateDate: | 12/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.