Provider Demographics
NPI:1811599368
Name:MONDT, PRISCILLA ANNE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:ANNE
Last Name:MONDT
Suffix:
Gender:F
Credentials:PHD, LPC
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 255
Mailing Address - Street 2:
Mailing Address - City:GREENLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72737-0255
Mailing Address - Country:US
Mailing Address - Phone:910-587-6053
Mailing Address - Fax:479-633-9398
Practice Address - Street 1:3901 W FINANCIAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1471
Practice Address - Country:US
Practice Address - Phone:479-986-8655
Practice Address - Fax:479-633-9398
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2001008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional