Healthcare Provider Details

I. General information

NPI: 1922331925
Provider Name (Legal Business Name): CLARENCE KEVIN BEDFORD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S 24TH ST
ROGERS AR
72758-1129
US

IV. Provider business mailing address

204 S 24TH ST
ROGERS AR
72758-1129
US

V. Phone/Fax

Practice location:
  • Phone: 479-621-0301
  • Fax: 479-899-6300
Mailing address:
  • Phone: 479-621-0301
  • Fax: 479-899-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP1003022
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1003022
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: