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General NPI Number Information
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NPI Number | 1437703543
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Entity Type | Individual
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Provider Name | JORDEN A KENREIGH-TOMAS MS, NCC, LAC
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Gender | Male
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 111 SE 22ND ST STE 11
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City | BENTONVILLE
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State | AR
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Zip | 72712-5180
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Country | US
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Telephone | 479-268-3280
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Fax | 479-268-3305
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Provider Business Mailing Address
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Address Line | 840 ILLINOIS AVE
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City | BENTONVILLE
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State | AR
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Zip | 72713-4081
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Country | US
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Telephone | 360-448-0999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A2411005
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License Number State | AR
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