Provider Demographics
NPI:1942804059
Name:BERG, KATELYN MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:MARIE
Last Name:BERG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:HELSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1815 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-336-1339
Practice Address - Street 1:2126 N 1ST ST
Practice Address - Street 2:STE F
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-2868
Practice Address - Country:US
Practice Address - Phone:501-982-5000
Practice Address - Fax:501-982-5007
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10094-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker