Individual
JASON WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3634 CENTRAL AVE STE A, HOT SPRINGS, AR 71913-6472
(501) 547-3763
Mailing address
3634 CENTRAL AVE STE A, HOT SPRINGS, AR 71913-6472
(501) 547-3763
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
A1708247
AR
101YM0800X
Mental Health Counselor
P2108017
AR
101YP2500X
Professional Counselor
Primary
P2108017
AR
171M00000X
Case Manager/Care Coordinator
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P2108017
LPC
AR
Enumeration date
12/21/2010
Last updated
10/27/2021
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