Provider Demographics
NPI:1720191109
Name:LAKEWOOD BEHAVIORAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:LAKEWOOD BEHAVIORAL HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:501-753-1616
Mailing Address - Street 1:4020 RICHARDS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2650
Mailing Address - Country:US
Mailing Address - Phone:501-753-1616
Mailing Address - Fax:501-753-8471
Practice Address - Street 1:4020 RICHARDS RD
Practice Address - Street 2:SUITE F
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2650
Practice Address - Country:US
Practice Address - Phone:501-753-1616
Practice Address - Fax:501-753-8471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8709020101YP2500X
ARP0108037101YP2500X
AR75-23P103TC0700X
AR989-C1041C0700X
ARC-68132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR33-DE3206OtherMEDICARE RAILROAD
AR33-DE3206OtherMEDICARE RAILROAD