Provider Demographics
NPI:1487707022
Name:MCDONALD, BARRY SEAMAN (PH D)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:SEAMAN
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 SO OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-6560
Mailing Address - Country:US
Mailing Address - Phone:870-535-2513
Mailing Address - Fax:870-535-2513
Practice Address - Street 1:1811 SO OLIVE ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-6560
Practice Address - Country:US
Practice Address - Phone:870-535-2513
Practice Address - Fax:870-535-2513
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8717P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145943744Medicaid
AR145601019Medicaid
AR145601019Medicaid