Healthcare Provider Details

I. General information

NPI: 1811653009
Provider Name (Legal Business Name): KRISTIN LEE TEMPLE M.ED., LPC, LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W MOUNTAIN ST STE 301
FAYETTEVILLE AR
72701-6022
US

IV. Provider business mailing address

PO BOX 655
FAYETTEVILLE AR
72702-0655
US

V. Phone/Fax

Practice location:
  • Phone: 479-222-0017
  • Fax:
Mailing address:
  • Phone: 479-222-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2307002
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: