Provider Demographics
NPI:1194118125
Name:BASSHAM, KELDA ELIZABETH (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:KELDA
Middle Name:ELIZABETH
Last Name:BASSHAM
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-3059
Mailing Address - Country:US
Mailing Address - Phone:870-378-1985
Mailing Address - Fax:
Practice Address - Street 1:100 E PLEASURE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7710
Practice Address - Country:US
Practice Address - Phone:501-387-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1807090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR333954744Medicaid