Provider Demographics
NPI:1518102755
Name:HAMMAN, KELLY MOSLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MOSLEY
Last Name:HAMMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHILDRENS WAY # 654
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-5150
Mailing Address - Fax:501-364-1592
Practice Address - Street 1:11 CHILDRENS WAY # 654
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-5150
Practice Address - Fax:501-364-1592
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2631-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4A136Medicare PIN