Provider Demographics
NPI:1407560055
Name:SANTELLANES, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SANTELLANES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:AR
Mailing Address - Zip Code:72727-2919
Mailing Address - Country:US
Mailing Address - Phone:760-985-3434
Mailing Address - Fax:
Practice Address - Street 1:1885 N CENTER ST
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:AR
Practice Address - Zip Code:72727-2919
Practice Address - Country:US
Practice Address - Phone:760-985-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR293893706Medicaid