Provider Demographics
NPI:1215079546
Name:TIGERT, MANDY (LPC)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:TIGERT
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-4201
Mailing Address - Country:US
Mailing Address - Phone:501-339-6625
Mailing Address - Fax:
Practice Address - Street 1:618 S KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-6419
Practice Address - Country:US
Practice Address - Phone:479-346-8340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1503014101YP2500X
ARA1112123101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional