Healthcare Provider Details

I. General information

NPI: 1609711316
Provider Name (Legal Business Name): KELLY JEAN ARTHUR CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LIGHTHOUSE DR
MOUNT HOPE WV
25880-9550
US

IV. Provider business mailing address

115 LIGHTHOUSE DR
MOUNT HOPE WV
25880-9550
US

V. Phone/Fax

Practice location:
  • Phone: 304-673-2555
  • Fax:
Mailing address:
  • Phone: 304-673-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number963
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: