Provider Demographics
NPI:1821249004
Name:STIDHAM, DANIEL TROY (MHPP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:TROY
Last Name:STIDHAM
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 NEWCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5280
Mailing Address - Country:US
Mailing Address - Phone:870-565-6440
Mailing Address - Fax:
Practice Address - Street 1:2805 NEWCASTLE DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5280
Practice Address - Country:US
Practice Address - Phone:870-565-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health