Provider Demographics
NPI:1629383013
Name:HEAD, MANDY LEIGH ANN (MHPP)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:LEIGH ANN
Last Name:HEAD
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-3014
Mailing Address - Country:US
Mailing Address - Phone:870-793-3199
Mailing Address - Fax:
Practice Address - Street 1:1141 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3014
Practice Address - Country:US
Practice Address - Phone:870-793-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR919629716171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator