Healthcare Provider Details

I. General information

NPI: 1043795958
Provider Name (Legal Business Name): JASON M ANDREWS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 MILITARY RD
BENTON AR
72015-2721
US

IV. Provider business mailing address

2909 MILITARY RD
BENTON AR
72015-2721
US

V. Phone/Fax

Practice location:
  • Phone: 501-800-5010
  • Fax:
Mailing address:
  • Phone: 501-800-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2006028
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA1807084
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: