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NPI Code Detail

MEDICARE: MRS. MALINDA EVETTE CHAMPION MHPP

MEDICARE: MRS. MALINDA EVETTE CHAMPION MHPP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorAR

General Provider Information

NPI Number : 1699924035
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MALINDA EVETTE CHAMPION MHPP
Provider Business Mailing Address
First Line : 5537 BLEAUX AVE
Second Line :
City : SPRINGDALE
State : AR
Zip : 72762-0737
Country : US
Telephone Number : 479-872-5580
Fax Number : 479-872-5581
Provider Business Practice Location Address
First Line : 412 N WASHINGTON AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-5616
Country : US
Telephone Number : 870-863-4611
Fax Number : 870-863-4962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2008
Last Update Date : 09/10/2008

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