Provider Demographics
NPI:1316969702
Name:BROWDER, SALLY (PHD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:BROWDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N UNIVERSITY AVE STE 675
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5234
Mailing Address - Country:US
Mailing Address - Phone:501-265-0237
Mailing Address - Fax:
Practice Address - Street 1:1501 N UNIVERSITY AVE
Practice Address - Street 2:STE 675
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5234
Practice Address - Country:US
Practice Address - Phone:501-223-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR02-13P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158097719Medicaid
AR5Y295OtherBLUE CROSS BLUE SHIELD
AR5Y295OtherBLUE CROSS BLUE SHIELD