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NPI Code Detail

MEDICARE: MARVIN EADY MHPP

MEDICARE: MARVIN EADY 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
1171M00000XCase Manager/Care Coordinator
2101YP2500XProfessional CounselorP1909118AR

General Provider Information

NPI Number : 1760873988
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARVIN EADY MHPP
Provider Business Mailing Address
First Line : 400 S MAIN ST STE 100
Second Line :
City : SEARCY
State : AR
Zip : 72143-7801
Country : US
Telephone Number : 501-279-9000
Fax Number :
Provider Business Practice Location Address
First Line : 2504 MCCAIN BLVD STE 118
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72116-7624
Country : US
Telephone Number : 501-812-6655
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2015
Last Update Date : 10/09/2024

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Directions to “ MARVIN EADY MHPP” Practice Location

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