Provider Demographics
NPI:1316490550
Name:ARD, WILLIAM KERREL JR (LMSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KERREL
Last Name:ARD
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 JEFFERSON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2736
Mailing Address - Country:US
Mailing Address - Phone:901-692-4411
Mailing Address - Fax:
Practice Address - Street 1:2038 JEFFERSON AVE APT 3
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2736
Practice Address - Country:US
Practice Address - Phone:901-692-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-24
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN105431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical