Provider Demographics
NPI:1144557588
Name:LITTLE, WILLIAM B JR (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:LITTLE
Suffix:JR
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 1:5349 ESTATE OFFICE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3620
Mailing Address - Country:US
Mailing Address - Phone:901-767-6351
Mailing Address - Fax:901-683-2876
Practice Address - Street 1:5349 ESTATE OFFICE DR STE 3
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-767-6351
Practice Address - Fax:901-683-2876
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR17-05P103T00000X
TNP0000003336103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ032478Medicaid