Healthcare Provider Details

I. General information

NPI: 1184877128
Provider Name (Legal Business Name): ERICA ELDRIDGE MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S CHEROKEE ST
MORRILTON AR
72110-2656
US

IV. Provider business mailing address

PO BOX 679
MORRILTON AR
72110-0679
US

V. Phone/Fax

Practice location:
  • Phone: 501-354-4589
  • Fax: 501-354-5410
Mailing address:
  • Phone: 501-354-4589
  • Fax: 501-354-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number920001372
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: