Provider Demographics
NPI:1437703543
Name:KENREIGH-TOMAS, JORDEN A (MS, NCC, LAC)
Entity type:Individual
Prefix:
First Name:JORDEN
Middle Name:A
Last Name:KENREIGH-TOMAS
Suffix:
Gender:M
Credentials:MS, NCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-4081
Mailing Address - Country:US
Mailing Address - Phone:360-448-0999
Mailing Address - Fax:
Practice Address - Street 1:111 SE 22ND ST STE 11
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5180
Practice Address - Country:US
Practice Address - Phone:479-268-3280
Practice Address - Fax:479-268-3305
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2024-11-07
Deactivation Date:2021-12-10
Deactivation Code:
Reactivation Date:2022-01-12
Provider Licenses
StateLicense IDTaxonomies
ARA2411005101YM0800X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health