Provider Demographics
NPI:1972040566
Name:LW BREWER WELLNESS ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:LW BREWER WELLNESS ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:501-246-0265
Mailing Address - Street 1:47 CRYSTALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5397
Mailing Address - Country:US
Mailing Address - Phone:501-246-0265
Mailing Address - Fax:501-734-8262
Practice Address - Street 1:2725 CANTRELL RD
Practice Address - Street 2:STE 106
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-2016
Practice Address - Country:US
Practice Address - Phone:501-246-0265
Practice Address - Fax:501-734-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10-00P261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1376792796OtherINDIVIDUAL NPI