Basic Information
| Provider Information | |||||||||
| NPI: | 1245421502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AARON | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A., CRC, LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5810 HIGHWAY 29 S | ||||||||
| Address2: | |||||||||
| City: | HOPE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718011039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707770632 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4323 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718541515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707730700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 07/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A0707053 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.