Healthcare Provider Details

I. General information

NPI: 1760873988
Provider Name (Legal Business Name): MARVIN EADY MHPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 MCCAIN BLVD STE 118
NORTH LITTLE ROCK AR
72116-7624
US

IV. Provider business mailing address

400 S MAIN ST STE 100
SEARCY AR
72143-7801
US

V. Phone/Fax

Practice location:
  • Phone: 501-812-6655
  • Fax:
Mailing address:
  • Phone: 501-279-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1909118
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: