Provider Demographics
NPI:1558038240
Name:DEWBRE, KATHY THYE
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:THYE
Last Name:DEWBRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7508
Mailing Address - Country:US
Mailing Address - Phone:501-353-5745
Mailing Address - Fax:
Practice Address - Street 1:12320 I-30 FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210
Practice Address - Country:US
Practice Address - Phone:501-455-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1807095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional