Provider Demographics
NPI:1790810042
Name:HOWELL, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HOWELL
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:BOX 187
Mailing Address - Street 2:HWY 144 N
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653
Mailing Address - Country:US
Mailing Address - Phone:870-265-6061
Mailing Address - Fax:870-265-2733
Practice Address - Street 1:1127 SECOND ST
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653
Practice Address - Country:US
Practice Address - Phone:870-265-3810
Practice Address - Fax:870-265-2733
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator