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Organization

LIVING WELL, PA

Active
Other names
LIVING WELL, PLLC
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JODY LYNN HAGEN PHD (PRESIDENT)
(501) 255-1574
Entity
Organization

Contact information

Practice address
1225 BRECKENRIDGE DR, SUITE 204, LITTLE ROCK, AR 72205-1558
(501) 255-1574
(501) 255-1446
Mailing address
PO BOX 206, MABELVALE, AR 72103-0206
(501) 255-1574
(501) 255-1446

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
04-16P
AR
103TC0700X
Clinical Psychologist
04-16P
AR
103TC2200X
Clinical Child & Adolescent Psychologist
04-16P
AR

Other

Enumeration date
09/23/2008
Last updated
09/23/2008
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