Organization
LIVING WELL, PA
Active
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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