Healthcare Provider Details

I. General information

NPI: 1306402169
Provider Name (Legal Business Name): JEFFREY DEAN LAWSON MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 TATE AVE
MAMMOTH SPRING AR
72554-8064
US

IV. Provider business mailing address

2012 HIGHWAY 62 412
HIGHLAND AR
72542-9477
US

V. Phone/Fax

Practice location:
  • Phone: 870-625-0273
  • Fax: 870-625-0275
Mailing address:
  • Phone: 870-856-3337
  • Fax: 870-856-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9494-M
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9494-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: