Provider Demographics
NPI:1316470735
Name:ELIZABETH CHAISSON, PHD, LLC
Entity type:Organization
Organization Name:ELIZABETH CHAISSON, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAISSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:479-422-5712
Mailing Address - Street 1:1 W MOUNTAIN ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-6068
Mailing Address - Country:US
Mailing Address - Phone:479-422-5712
Mailing Address - Fax:
Practice Address - Street 1:1 W MOUNTAIN ST
Practice Address - Street 2:SUITE 307
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6068
Practice Address - Country:US
Practice Address - Phone:479-422-5712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR-PL 15-03P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty