Provider Demographics
NPI:1932559671
Name:CROSBY, KAITLYN (LPC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:CROSBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAILTYN
Other - Middle Name:
Other - Last Name:BODENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2812 DALEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-2614
Mailing Address - Country:US
Mailing Address - Phone:501-749-4990
Mailing Address - Fax:501-749-4991
Practice Address - Street 1:2812 DALEWOOD RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-2614
Practice Address - Country:US
Practice Address - Phone:501-749-4990
Practice Address - Fax:501-660-6830
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1910127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty