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General NPI Number Information
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NPI Number | 1215079546
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Entity Type | Individual
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Provider Name | MANDY TIGERT LPC
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 618 S KNOXVILLE AVE
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-6419
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Country | US
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Telephone | 479-346-8340
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Fax |
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Provider Business Mailing Address
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Address Line | 515 S 4TH ST
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City | DARDANELLE
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State | AR
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Zip | 72834-4201
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Country | US
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Telephone | 501-339-6625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1503014
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License Number State | AR
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