Provider Demographics
NPI:1427417823
Name:PROTHRO, KELSEY RENEE (LAC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RENEE
Last Name:PROTHRO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MADISON 7337
Mailing Address - Street 2:
Mailing Address - City:HINDSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72738-9067
Mailing Address - Country:US
Mailing Address - Phone:501-422-8273
Mailing Address - Fax:
Practice Address - Street 1:1925 W BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5012
Practice Address - Country:US
Practice Address - Phone:501-422-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1807089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty