Healthcare Provider Details

I. General information

NPI: 1376468900
Provider Name (Legal Business Name): HEIDI MANATT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 MCCAIN PARK DR STE 104
NORTH LITTLE ROCK AR
72116-7813
US

IV. Provider business mailing address

109 GEORGANNE LN
LITTLE ROCK AR
72223-8010
US

V. Phone/Fax

Practice location:
  • Phone: 501-416-6753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2607025
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: