Individual provider Active NPI

McKala Alyssa Dillard, LCSW

  • Clinical Social Worker
  • Fort Smith, AR
National Provider Identifier
1043951106
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11508-C Issued in AR
Practice address
3111 S 70TH St
Fort Smith, AR 72903-5017
Phone
(479) 452-6650
Fax
(479) 785-9495
NPI assigned
Apr 5, 2022
Last updated
Apr 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 11508-M AR
Clinical Social Worker 1041C0700X 11508-C AR Primary

Addresses

Primary practice location

3111 S 70TH St
Fort Smith, AR 72903-5017

Mailing address

3111 S 70TH St
Fort Smith, AR 72903-5017
Phone (479) 452-6650

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240412003507 AR Practitioner - Clinical Social Worker 5799124533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

3117 S 70TH St
The Guidance Center Primary Care
Fort Smith, AR 72903-5017
Phone (479) 785-9400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11508-MARMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Western Arkansas Counseling & Guidance Center, Inc CurrentSince Mar 29, 2024 Accepting new patients
The Guidance Center - Whole Health CurrentSince Mar 29, 2024 Accepting new patients

Locations

3111 S 70th St
Fort Smith, AR 72903

3117 S 70th St
Fort Smith, AR 72903
Phone (479) 785-9400

1857 Rice St
Waldron, AR 72958
Phone (479) 637-2468

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1043951106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 S 70TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035017",
            "telephone_number": "479-452-6650",
            "fax_number": "479-785-9495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 S 70TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035017",
            "telephone_number": "479-452-6650",
            "fax_number": "479-785-9495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLARD",
        "first_name": "MCKALA",
        "middle_name": "ALYSSA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AR",
            "license": "11508-M",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "11508-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.