Provider Demographics
NPI:1568794725
Name:CLARK, KENNETH ANDREW II (LAMFT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ANDREW
Last Name:CLARK
Suffix:II
Gender:M
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DUQUESNE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3917
Mailing Address - Country:US
Mailing Address - Phone:501-781-2230
Mailing Address - Fax:888-816-7916
Practice Address - Street 1:10800 FINANCIAL CENTRE PKWY STE 290
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3581
Practice Address - Country:US
Practice Address - Phone:501-781-2230
Practice Address - Fax:888-816-7916
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM1206006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist