Provider Demographics
NPI:1811003742
Name:TANNEHILL, RHONDA LAURENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:LAURENE
Last Name:TANNEHILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:MOUNT IDA
Mailing Address - State:AR
Mailing Address - Zip Code:71957-0734
Mailing Address - Country:US
Mailing Address - Phone:870-356-5718
Mailing Address - Fax:870-356-5719
Practice Address - Street 1:2268 HIGHWAY 8 E
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:AR
Practice Address - Zip Code:71960-8508
Practice Address - Country:US
Practice Address - Phone:870-356-5718
Practice Address - Fax:870-356-5719
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR98-10P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR227176719Medicaid
AR710831320OtherPPO PLUS ID
AR137-635OtherMHS NUMBER
AR72099OtherAMERICAN LIFE PAYRO ID
AR184725OtherMANAGED HEALTH NETWORK ID
AR710831320OtherTRICARE PROVIDER NUMBER
AR61-74982OtherUNITED BEHAVIORAL HEALTH
AR138757719Medicaid
AR72099OtherAMERICAN LIFE PAYRO ID
AR61-74982OtherUNITED BEHAVIORAL HEALTH