Provider Demographics
NPI:1083290191
Name:CLINKENBEARD, LORI (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:CLINKENBEARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LORIN
Other - Middle Name:
Other - Last Name:CLINKENBEARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27355 N 91ST LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5159
Mailing Address - Country:US
Mailing Address - Phone:160-282-0303
Mailing Address - Fax:
Practice Address - Street 1:34975 N NORTH VALLEY PKWY STE 152
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-4032
Practice Address - Country:US
Practice Address - Phone:480-525-7091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health