Healthcare Provider Details

I. General information

NPI: 1831076306
Provider Name (Legal Business Name): KAITLYNN ROSEANNE GARRETT LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 HALBERT ST
MALVERN AR
72104-2607
US

IV. Provider business mailing address

829 HALBERT ST
MALVERN AR
72104-2607
US

V. Phone/Fax

Practice location:
  • Phone: 501-332-4400
  • Fax: 501-332-4403
Mailing address:
  • Phone: 501-332-4400
  • Fax: 501-332-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2508004
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: