Healthcare Provider Details

I. General information

NPI: 1265162937
Provider Name (Legal Business Name): KELLY POGUE STEPHENS LPC/LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MEDICAL LN STE H
CONWAY AR
72034-4918
US

IV. Provider business mailing address

23 FOUR MILE HILL RD
VILONIA AR
72173-5001
US

V. Phone/Fax

Practice location:
  • Phone: 501-255-3755
  • Fax:
Mailing address:
  • Phone: 501-908-2897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2401020
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2503015
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: