Healthcare Provider Details

I. General information

NPI: 1437706884
Provider Name (Legal Business Name): KEVIN KIRKPATRICK SR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 09/01/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 POPLAR PL
ROGERS AR
72756-4249
US

IV. Provider business mailing address

1106 POPLAR PL
ROGERS AR
72756-4249
US

V. Phone/Fax

Practice location:
  • Phone: 479-372-6464
  • Fax:
Mailing address:
  • Phone: 479-372-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1910122
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: