Provider Demographics
NPI:1952894545
Name:MAYALL, KELLI (LPC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:MAYALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71857-7510
Mailing Address - Country:US
Mailing Address - Phone:870-703-9508
Mailing Address - Fax:
Practice Address - Street 1:4613 PARKWAY DR STE 7
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1191
Practice Address - Country:US
Practice Address - Phone:870-330-4095
Practice Address - Fax:844-706-5741
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1711325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health