Individual
MRS. KATHLEEN ELLEN CLENDENEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LMFT
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
P0405018
AR
106H00000X
Marriage & Family Therapist
M0408002
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5X992
BLUE SHIELD PROVIDER #
AR
Enumeration date
06/23/2006
Last updated
02/04/2016
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