Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | AR 75-26P | AR |
N | 103TC0700X | Clinical Psychologist | AR 75-26P | AR |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | AR 75-26P | AR |
NPI | 1023087129 |
---|---|
Provider Name | Larry Clarke |
First Address | Little Rock, AR 72211-3858 |
Second Address | Little Rock, AR 72211-3858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 09/07/2007 |