Kelli Mayall, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A1711325 Issued in AR

Practice address

4613 Parkway Dr Ste 7
Texarkana, AR 71854-1191

Phone

(870) 330-4095

Fax

(844) 706-5741

NPI assigned

Jun 8, 2018

Last updated

May 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Moonbrook Mind and Body Integrative Services IncorporatedGroup PAC ID 4284054735, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Moonbrook Mind & Body Integrative Services Incorporated

  • Clinical Social Worker
  • Texarkana, AR
  • NPI 1376173401
  Medicare reassignment Care Compare group NPD
• Cornerstone Counseling Clinic, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Nashville, AR
  • NPI 1851819544
  Medicare reassignment NPD
• TFS of Gurdon Inc

  dba Therapeutic Family Services

  • Community/Behavioral Health Agency
  • Malvern, AR
  • NPI 1639180805
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1952894545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2726 HIGHWAY 19 N",
            "city": "PRESCOTT",
            "state": "AR",
            "postal_code": "718577510",
            "telephone_number": "870-703-9508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4613 PARKWAY DR STE 7",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541191",
            "telephone_number": "870-330-4095",
            "fax_number": "844-706-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYALL",
        "first_name": "KELLI",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-08",
        "last_updated": "2024-05-10",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A1711325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Martin
• Warren Gregory Martindale
• Enitan Omowunmi Martins, M.D.
• Deanna Marie Matlock, FNP-C
• Pamela May, APRN
• Russell Eugene Mayo, MD
• Mark McAlister, LMSW
• Michael J McAllister, PHD
• Anna M McBee
• James Kevin McCann, FNP-BC

• Mental Health Counselor in Texarkana, AR
• Providers in Texarkana, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.