Provider Demographics
NPI:1639991946
Name:PRATHER, SIMEON CALEB
Entity type:Individual
Prefix:
First Name:SIMEON
Middle Name:CALEB
Last Name:PRATHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 A ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4070
Mailing Address - Country:US
Mailing Address - Phone:501-516-1081
Mailing Address - Fax:
Practice Address - Street 1:4101 A ST APT 2
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4070
Practice Address - Country:US
Practice Address - Phone:501-516-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging