| NPI | 1316197759 |
|---|---|
| Former Legal Business Name | LIVING WELL, PLLC |
| Entity Type | Organization |
| Authorized Contact | JODY LYNN HAGEN President 501-255-1574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AR 04-16P) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AR 04-16P) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: AR 04-16P) | |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2008-09-23 |