Calvin J. Kirklin, PH.D,LPC, NCC
Individual provider Active NPI Counselor · Alexander, AR
NPI 1477066322 · NPPES record last updated Jul 18, 2024
Key facts
- NPI
- 1477066322
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- C6865 (OR)
- Practice address
- 1501 Woody Dr
Alexander, AR 72002-9420 - Phone
- (501) 682-9800
- NPI assigned
- Nov 14, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P1911138 | AR | MD | Counselor |
| C6865 | OR | MD | Counselor |
| 88695 | TX | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rite of Passage, Inc | Current |
Accepting new patients | |
| Youth Home Inc | Past | Accepting new patients |
Locations
1501 Woody Dr
Alexander, AR 72002
Phone (501) 682-9800
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/youthhome/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | C6865 | OR | Yes |
| Counselor | 101Y00000X | 88695 | TX | |
| Counselor | 101Y00000X | P1911138 | AR |
Addresses
Primary practice location
1501 Woody Dr
Alexander, AR 72002-9420
Mailing address
1501 Woody Dr
Alexander, AR 72002-9420
Phone (501) 682-9800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477066322 | Medicaid | AR |
Other providers in Alexander, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.