Individual
KELLY DENISE LIVINGSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, PLPE
Contact information
Practice address
1100 BOB COURTWAY DR, CONWAY, AR 72032-4766
(501) 328-5525
(501) 328-5342
Mailing address
1100 BOB COURTWAY DR, CONWAY, AR 72032-4766
(501) 328-5525
(501) 328-5342
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
09-45AE-PL
AR
103TC1900X
Counseling Psychologist
Primary
11-09AE-PL
AR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
08/27/2009
Last updated
05/01/2012
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