Provider Demographics
NPI:1710943808
Name:MILLIGAN, CLARK (LPC, LMFT, EDD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:LPC, LMFT, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5947
Mailing Address - Country:US
Mailing Address - Phone:479-442-2457
Mailing Address - Fax:479-442-0159
Practice Address - Street 1:301 W MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5947
Practice Address - Country:US
Practice Address - Phone:479-442-2457
Practice Address - Fax:479-442-0159
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9201004101YP2500X
ARM9903003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S426OtherBC/BS #