Provider Demographics
NPI:1922601178
Name:FELTON, LAURA BETH (LPC, BCBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:FELTON
Suffix:
Gender:F
Credentials:LPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 HIGHWAY 1 N
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-9300
Mailing Address - Country:US
Mailing Address - Phone:870-768-5676
Mailing Address - Fax:
Practice Address - Street 1:2331 HIGHWAY 1 N
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:AR
Practice Address - Zip Code:72360-9300
Practice Address - Country:US
Practice Address - Phone:870-768-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1905058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional