Provider Demographics
NPI:1982776936
Name:HEARD, KENNETH JOE (LPC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOE
Last Name:HEARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7025
Mailing Address - Country:US
Mailing Address - Phone:501-231-6166
Mailing Address - Fax:501-847-0008
Practice Address - Street 1:4717 BOONE RD
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-6218
Practice Address - Country:US
Practice Address - Phone:501-847-0008
Practice Address - Fax:501-776-2246
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8012118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional