Provider Demographics
NPI:1669437547
Name:KISTNER, LORY SAXTON (LCSW)
Entity type:Individual
Prefix:
First Name:LORY
Middle Name:SAXTON
Last Name:KISTNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORY
Other - Middle Name:SAXTON
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10025 WEST MARKHAM ST
Mailing Address - Street 2:STE. 210
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-663-5473
Mailing Address - Fax:501-801-1816
Practice Address - Street 1:10025 WEST MARKHAM ST
Practice Address - Street 2:STE. 210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-663-5473
Practice Address - Fax:501-801-1816
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1881-C101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor