Healthcare Provider Details

I. General information

NPI: 1740089929
Provider Name (Legal Business Name): MENTAL WELLNESS CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MAIN ST
NORTH LITTLE ROCK AR
72114-5329
US

IV. Provider business mailing address

513 MAIN ST
NORTH LITTLE ROCK AR
72114-5329
US

V. Phone/Fax

Practice location:
  • Phone: 501-777-5969
  • Fax:
Mailing address:
  • Phone: 501-777-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLEE MCCOY
Title or Position: PRESIDENT
Credential: LPC, LMFT
Phone: 501-722-3264