Healthcare Provider Details

I. General information

NPI: 1346564648
Provider Name (Legal Business Name): KELLY R. MEARS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY R. MEARS

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MORGAN ST SUITE 8
PARAGOULD AR
72450-3949
US

IV. Provider business mailing address

1815 PLEASANT GROVE ROAD
JONESBORO AR
72405-7870
US

V. Phone/Fax

Practice location:
  • Phone: 870-335-9483
  • Fax: 870-335-9487
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1201008
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: