Provider Demographics
NPI:1023087129
Name:CLARKE, LARRY (PHD (PSYCHOLOGIST))
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:CLARKE
Suffix:
Gender:M
Credentials:PHD (PSYCHOLOGIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11219 FINANCIAL CENTRE PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3858
Mailing Address - Country:US
Mailing Address - Phone:501-224-8393
Mailing Address - Fax:501-224-2849
Practice Address - Street 1:11219 FINANCIAL CENTRE PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3858
Practice Address - Country:US
Practice Address - Phone:501-224-8393
Practice Address - Fax:501-224-2849
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR 75-26P103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent