Provider Demographics
NPI:1356615876
Name:HODGES, JUSTIN (MHPP)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HODGES
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:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-0245
Mailing Address - Country:US
Mailing Address - Phone:501-745-4448
Mailing Address - Fax:501-745-8826
Practice Address - Street 1:1160 WALKER ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6621
Practice Address - Country:US
Practice Address - Phone:501-745-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator