Provider Demographics
NPI:1336380559
Name:LETBETTER, KELLIE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:LYNN
Last Name:LETBETTER
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 1:1600 SW BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:AR
Mailing Address - Zip Code:72433-2419
Mailing Address - Country:US
Mailing Address - Phone:870-886-7200
Mailing Address - Fax:870-886-7201
Practice Address - Street 1:1600 SW BROAD ST
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:AR
Practice Address - Zip Code:72433-2419
Practice Address - Country:US
Practice Address - Phone:870-886-7200
Practice Address - Fax:870-886-7201
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4716-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical