Healthcare Provider Details

I. General information

NPI: 1558718320
Provider Name (Legal Business Name): CASSANDRA LYNN ELLEDGE LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COLONIAL SQ
CLARKSVILLE AR
72830-3633
US

IV. Provider business mailing address

3 COLONIAL SQ
CLARKSVILLE AR
72830-3633
US

V. Phone/Fax

Practice location:
  • Phone: 479-647-9155
  • Fax: 479-777-7756
Mailing address:
  • Phone: 479-647-9155
  • Fax: 479-777-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: