Provider Demographics
NPI:1326220856
Name:FAIRRIS, KELLI JEAN (MSE, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:JEAN
Last Name:FAIRRIS
Suffix:
Gender:F
Credentials:MSE, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 US HIGHWAY 371
Mailing Address - Street 2:PO BOX 357
Mailing Address - City:PRESCOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71857-7064
Mailing Address - Country:US
Mailing Address - Phone:870-887-3660
Mailing Address - Fax:870-887-3705
Practice Address - Street 1:1658 US HIGHWAY 371
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AR
Practice Address - Zip Code:71857-7064
Practice Address - Country:US
Practice Address - Phone:870-887-3660
Practice Address - Fax:870-887-3705
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1011073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional