Healthcare Provider Details

I. General information

NPI: 1326320912
Provider Name (Legal Business Name): ANDREA KELLIM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 LINWOOD DR STE B
PARAGOULD AR
72450-5365
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 870-604-4455
  • Fax: 888-977-2956
Mailing address:
  • Phone: 870-972-1268
  • Fax: 870-934-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0610058
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: