Healthcare Provider Details

I. General information

NPI: 1336380559
Provider Name (Legal Business Name): KELLIE LYNN LETBETTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW BROAD ST
HOXIE AR
72433-2419
US

IV. Provider business mailing address

1600 SW BROAD ST
HOXIE AR
72433-2419
US

V. Phone/Fax

Practice location:
  • Phone: 870-886-7200
  • Fax: 870-886-7201
Mailing address:
  • Phone: 870-886-7200
  • Fax: 870-886-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4716-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: