Provider Demographics
NPI:1659801769
Name:LEWALLEN & FELTY PLLC
Entity Type:Organization
Organization Name:LEWALLEN & FELTY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:LEWALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:870-926-5710
Mailing Address - Street 1:611 COUNTY ROAD 763
Mailing Address - Street 2:
Mailing Address - City:BROOKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72417-8951
Mailing Address - Country:US
Mailing Address - Phone:870-926-5710
Mailing Address - Fax:
Practice Address - Street 1:2210 W KINGSHIGHWAY STE 9
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3987
Practice Address - Country:US
Practice Address - Phone:870-926-5710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)