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General NPI Number Information
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NPI Number | 1982776936
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Entity Type | Individual
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Provider Name | KENNETH JOE HEARD LPC
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 4717 BOONE RD
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City | BRYANT
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State | AR
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Zip | 72022-6218
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Country | US
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Telephone | 501-847-0008
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Fax | 501-776-2246
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Provider Business Mailing Address
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Address Line | 3616 INDEPENDENCE DR
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City | BRYANT
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State | AR
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Zip | 72022-7025
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Country | US
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Telephone | 501-231-6166
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Fax | 501-847-0008
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P8012118
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License Number State | AR
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