MRS. KELLYE GAUTIER LPC
NPI 1104272616
Counselor - Professional in Bentonville, AR

Q: What is Kellye Gautier's NPI number?

The NPI number for Kellye Gautier is 1104272616. It was assigned to this individual provider in the NPPES registry on May 13, 2016.

Q: What is Kellye Gautier's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Kellye Gautier was last updated on October 17, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since May 13, 2016PECOS EnrolledAccepts Medicare Assignment

2003 SE WALTON BLVD, BENTONVILLE, AR 72712(479) 725-6000(479) 750-4843 Get Directions Write a Review

NPPES record last updated: October 17, 2018. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Oct 17, 2018, Aug 10, 2018, Jan 31, 2017 and 1 more (4 updates tracked since 2016).

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About Mrs. Kellye Gautier Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. KELLYE GAUTIER LPC (NPI 1104272616) is an individual professional provider in Bentonville, Arkansas, licensed in Arkansas (P1810135) and active in the NPI registry since May 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2014).

NPPES Registry Identity

NPI1104272616

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameMRS. KELLYE GAUTIERCredential: LPC

Location Address2003 SE WALTON BLVDBentonville, AR 72712-3725

Mailing Address2400 S 48th StSpringdale, AR 72762-6683 · (479) 750-2020 · Fax (479) 750-4843

Phone(479) 725-6000

Fax(479) 750-4843

Sole ProprietorNo

Medical School CMSOtherGraduated 2014

Enumeration DateMay 13, 2016

Last NPPES UpdateOctober 17, 20184 updates tracked since enumeration

✔ NPI 1104272616 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in AR · P1810135

Also ListedMarriage & Family TherapistTaxonomy 106H00000X · License F1411018 (AR)

2003 SE WALTON BLVD, Bentonville, AR 72712

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Arkansas Blue Cross and Blue Shield, Health Advantage, Octave.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Kellye Gautier Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6406330208

PECOS Enrollment IDI20260319002639

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MOLLY E MURRAY MHPP

Case Manager/Care Coordinator