Provider Demographics
NPI:1871832196
Name:CARLTON, KELLYE FLEMMING (LPC)
Entity type:Individual
Prefix:
First Name:KELLYE
Middle Name:FLEMMING
Last Name:CARLTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLYE
Other - Middle Name:E
Other - Last Name:FLEMMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2360 N SILK ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6402
Mailing Address - Country:US
Mailing Address - Phone:479-502-4943
Mailing Address - Fax:479-431-5099
Practice Address - Street 1:112 E SUNBRIDGE DR STE 7
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-502-4943
Practice Address - Fax:479-431-5099
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1306064101YM0800X
ARP1603035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health