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MR. BRENT PAUL EZELL MHPP

>> Case Manager/Care Coordinator >> Other Service Providers

Registrant NPI Number: 1003225301

Individual Registrant:
MR. BRENT PAUL EZELL MHPP
Gender: M
Not Sole Proprietor

Location and contact information for practice:
111 S 3RD AVE  PIGGOTT, AR 72454-2634 US
Tel: 870-598-0306  Fax: 870-598-0328

Contact information for business:
1815 PLEASANT GROVE RD  JONESBORO, AR 72401-7870 US
Tel: 870-933-6886  Fax: 870-933-9395

Registration Information:
NPI: 1003225301
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N171M00000XOther Service Providers
Case Manager/Care Coordinator
Y171M00000XOther Service Providers
Case Manager/Care Coordinator
AR

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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