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General NPI Number Information
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NPI Number | 1689134330
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Entity Type | Individual
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Provider Name | KELSEY SANDEFUR MA, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 17 BUSINESS PARK DR STE 12
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City | GREENBRIER
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State | AR
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Zip | 72058-9295
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Country | US
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Telephone | 501-733-1453
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Fax | 501-426-8091
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Provider Business Mailing Address
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Address Line | 17 BUSINESS PARK DR STE 13
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City | GREENBRIER
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State | AR
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Zip | 72058-9295
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Country | US
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Telephone | 501-733-1453
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Fax | 501-426-8091
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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 | A1903039
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2102153
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License Number State | AR
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