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General NPI Number Information
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NPI Number | 1427417823
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Entity Type | Individual
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Provider Name | KELSEY RENEE PROTHRO LAC.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1925 W BEEBE CAPPS EXPY
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City | SEARCY
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State | AR
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Zip | 72143-5012
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Country | US
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Telephone | 501-422-8273
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Fax |
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Provider Business Mailing Address
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Address Line | 162 MADISON 7337
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City | HINDSVILLE
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State | AR
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Zip | 72738-9067
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Country | US
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Telephone | 501-422-8273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | P1807089
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License Number State | AR
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