# MIRACLE KIDS SUCCESS ACADEMY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568799658
- **Authorized official:** SHELLY KELLER MCD, CCC-SLP (OWNER/PRESIDENT)
- **Authorized official phone:** (870) 932-3600

## Contact information

- **Practice address:** 1900 STILLWATER DR, JONESBORO, AR 72404-9119
- **Practice address phone:** (870) 932-3600
- **Practice address fax:** (870) 932-3611
- **Mailing address:** 1900 STILLWATER DR, JONESBORO, AR 72404-9119
- **Mailing address phone:** (870) 932-3600
- **Mailing address fax:** (870) 932-3611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/10/2009
- **Last updated:** 11/30/2020