Individual
JASON WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
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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