Healthcare Provider Details

I. General information

NPI: 1477066322
Provider Name (Legal Business Name): CALVIN J. KIRKLIN PH.D,LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 07/18/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WOODY DR
ALEXANDER AR
72002-9420
US

IV. Provider business mailing address

1501 WOODY DR
ALEXANDER AR
72002-9420
US

V. Phone/Fax

Practice location:
  • Phone: 501-682-9800
  • Fax:
Mailing address:
  • Phone: 501-682-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC6865
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number88695
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP1911138
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: