Provider Demographics
NPI:1184260408
Name:SELL, DOUGLAS M (PHD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:SELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1630
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-1475
Mailing Address - Country:US
Mailing Address - Phone:501-467-3485
Mailing Address - Fax:
Practice Address - Street 1:ARKANSAS DEPT. OF CORRECTION
Practice Address - Street 2:100 WALCO LANE
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104
Practice Address - Country:US
Practice Address - Phone:501-467-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09-04P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR09-04POtherARKANSAS LICENSE NUMBER