Healthcare Provider Details

I. General information

NPI: 1396158564
Provider Name (Legal Business Name): LUDWIG JAMES ASZOD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S ROGERS ST STE C
CLARKSVILLE AR
72830-4331
US

IV. Provider business mailing address

3012 WEST MAIN STREET
CLARKSVILLE AR
72830-8007
US

V. Phone/Fax

Practice location:
  • Phone: 479-774-2131
  • Fax:
Mailing address:
  • Phone: 479-774-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1410082
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1410082
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: