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General NPI Number Information
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NPI Number | 1790068906
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Entity Type | Individual
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Provider Name | KENNETH EDWARD HOUSE LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 2779 WEST RD
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-6873
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Country | US
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Telephone | 870-404-7735
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Fax |
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Provider Business Mailing Address
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Address Line | 2779 WEST ROAD
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653
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Country | US
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Telephone | 870-404-7735
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1287-C
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License Number State | AR
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