Provider Demographics
NPI:1962619494
Name:GODSEY, MANDREA JEANETTE (BSCD MHPP)
Entity type:Individual
Prefix:MRS
First Name:MANDREA
Middle Name:JEANETTE
Last Name:GODSEY
Suffix:
Gender:F
Credentials:BSCD MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 REAMS AVE
Mailing Address - Street 2:
Mailing Address - City:GOSNELL
Mailing Address - State:AR
Mailing Address - Zip Code:72315-5719
Mailing Address - Country:US
Mailing Address - Phone:870-532-5953
Mailing Address - Fax:
Practice Address - Street 1:1510 BYRUM RD
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-8033
Practice Address - Country:US
Practice Address - Phone:870-532-2600
Practice Address - Fax:870-532-8494
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator