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General NPI Number Information
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NPI Number | 1760873988
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Entity Type | Individual
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Provider Name | MARVIN EADY MHPP
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Gender | Male
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 2504 MCCAIN BLVD STE 118
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7624
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Country | US
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Telephone | 501-812-6655
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Fax |
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Provider Business Mailing Address
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Address Line | 400 S MAIN ST STE 100
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City | SEARCY
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State | AR
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Zip | 72143-7801
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Country | US
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Telephone | 501-279-9000
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1909118
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License Number State | AR
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