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General NPI Number Information
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NPI Number | 1871832196
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Entity Type | Individual
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Provider Name | KELLYE FLEMMING CARLTON LPC
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Gender | Female
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 112 E SUNBRIDGE DR STE 7
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-502-4943
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Fax | 479-431-5099
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Provider Business Mailing Address
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Address Line | 2360 N SILK ROSE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-6402
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Country | US
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Telephone | 479-502-4943
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Fax | 479-431-5099
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A1306064
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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 | P1603035
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License Number State | AR
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