Provider Demographics
NPI:1245421502
Name:AARON, PHILIP WAYNE (MA, CRC, LAC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:WAYNE
Last Name:AARON
Suffix:
Gender:M
Credentials:MA, CRC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 HIGHWAY 29 S
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-1039
Mailing Address - Country:US
Mailing Address - Phone:870-777-0632
Mailing Address - Fax:
Practice Address - Street 1:4323 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1515
Practice Address - Country:US
Practice Address - Phone:870-773-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0707053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health