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NPI Code Detail

MEDICARE: KENNETH ANDREW CLARK II LAMFT

MEDICARE: KENNETH ANDREW CLARK II LAMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistM1206006AR

General Provider Information

NPI Number : 1568794725
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH ANDREW CLARK II LAMFT
Provider Business Mailing Address
First Line : 24 DUQUESNE DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72223-3917
Country : US
Telephone Number : 501-781-2230
Fax Number : 888-816-7916
Provider Business Practice Location Address
First Line : 10800 FINANCIAL CENTRE PKWY STE 290
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-3581
Country : US
Telephone Number : 501-781-2230
Fax Number : 888-816-7916
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2010
Last Update Date : 06/25/2013

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