Basic Information
| Provider Information | |||||||||
| NPI: | 1194118125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INNESS | ||||||||
| FirstName: | KELDA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LPC, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 SKYLINE DR | ||||||||
| Address2: | |||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 728013362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799675570 | ||||||||
| FaxNumber: | 4798905364 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | HEBER SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799681298 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2015 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P1807090 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.