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General NPI Number Information
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NPI Number | 1144320516
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Entity Type | Organization
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Legal Business Name | AT PEACE COUNSELING CENTER INC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5 A MEDICAL LANE
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City | CONWAY
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State | AR
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Zip | 72034
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Country | US
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Telephone | 501-764-4400
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Fax | 501-764-0049
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Provider Business Mailing Address
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Address Line | 5 A MEDICAL LANE
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City | CONWAY
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State | AR
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Zip | 72034
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Country | US
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Telephone | 501-764-4400
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Fax | 501-764-0049
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Authorized Official
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Title or Position | CLINICAL DIRECTOR OWNER
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Name | KATHY JEAN KELLS
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Credential | LPC NCC
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Telephone | 501-764-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | AR
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