Provider Demographics
NPI:1518162163
Name:MWL CLINICAL SERVICES
Entity Type:Organization
Organization Name:MWL CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW PA
Authorized Official - Phone:501-351-1510
Mailing Address - Street 1:107 SECLUDED CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-1734
Mailing Address - Country:US
Mailing Address - Phone:501-351-1510
Mailing Address - Fax:
Practice Address - Street 1:1100 N UNIVERSITY AVE
Practice Address - Street 2:108
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6343
Practice Address - Country:US
Practice Address - Phone:501-351-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1151-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1511-COtherLICENSE