Organization
FAYETTE-KIDS COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLYE CARLTON LPC (MENTAL HEALTH COUNSELOR)
(479) 502-4943
Entity
Organization
Contact information
Practice address
112 E SUNBRIDGE DR STE 7, FAYETTEVILLE, AR 72703-2860
(479) 502-4943
Mailing address
1395 E ASH ST, FAYETTEVILLE, AR 72703-3060
(479) 502-4943
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871832196
NPI
AR
Enumeration date
06/25/2019
Last updated
06/25/2019
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