| Doctor Name: | KELLY MARIE ELEDGE |
| NPI Number: | 1386809218 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PROVISIONAL MHP |
| License Number: | PLMSW |
| Business Practice Address: | 250 E Centerton Blvd Centerton, AR - 727199240 |
| Business Phone Number: | 4797951802 |
| Business Fax Number: | 4797958303 |
| Mailing Address: | 250 E Centerton Blvd, CENTERTON |
| State: | AR |
| Postal Code: | 727199240 |
| Phone Number: | 4797951802 |
| Fax Number: | 4797958303 |
| NPI Enumeration Date: | 07/21/2008 |
| NPI Last Update Date: | 11/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | PLMSW |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |