# MIRACLE KIDS SUCCESS ACADEMY NORTH

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

## Provider details

- **NPI number:** 1912813874
- **Authorized official:** SHELLY A. KELLER (CEO)
- **Authorized official phone:** (870) 932-3600

## Contact information

- **Practice address:** 806 GLENDALE ST, JONESBORO, AR 72401-4455
- **Practice address phone:** (870) 333-2600
- **Practice address fax:** (870) 300-2337
- **Mailing address:** 806 GLENDALE ST, JONESBORO, AR 72401-4455
- **Mailing address phone:** (870) 333-2600
- **Mailing address fax:** (870) 300-2337

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 08/20/2026
- **Last updated:** 08/20/2026