Provider Demographics
NPI:1962080192
Name:BRAMLETT, RONALD (PHD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BRAMLETT
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 1:25 WINDWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9609
Mailing Address - Country:US
Mailing Address - Phone:501-472-1807
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF PSYCHOLOGY AND COUNSELING 201 DONAGHEY
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72035-0001
Practice Address - Country:US
Practice Address - Phone:501-450-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR92-11P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist