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General NPI Number Information
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NPI Number | 1851401806
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Entity Type | Individual
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Provider Name | KATHY JEAN KELLS LPC NCC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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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 | 401-764-0049
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Provider Business Mailing Address
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Address Line | 2 LAURA 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 |
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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 | P0411050
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License Number State | AR
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