Healthcare Provider Details

I. General information

NPI: 1972040566
Provider Name (Legal Business Name): LW BREWER WELLNESS ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 CANTRELL RD STE 106
LITTLE ROCK AR
72202-2016
US

IV. Provider business mailing address

47 CRYSTALWOOD DR
LITTLE ROCK AR
72210-5397
US

V. Phone/Fax

Practice location:
  • Phone: 501-246-0265
  • Fax: 501-734-8262
Mailing address:
  • Phone: 501-246-0265
  • Fax: 501-734-8262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number10-00P
License Number StateAR

VIII. Authorized Official

Name: DR. LINDA W BREWER
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 501-246-0265