Provider Demographics
NPI:1346597531
Name:HYMAN, MALISSA DAWN
Entity Type:Individual
Prefix:MRS
First Name:MALISSA
Middle Name:DAWN
Last Name:HYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 N STATE LINE AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-3583
Mailing Address - Country:US
Mailing Address - Phone:870-774-1333
Mailing Address - Fax:870-774-1334
Practice Address - Street 1:2118 N STATE LINE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-3583
Practice Address - Country:US
Practice Address - Phone:870-774-1333
Practice Address - Fax:870-774-1334
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1506059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health