Jordan Smith

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1628 E Page Ave
Malvern, AR 72104-4524

Phone

(501) 315-3344

NPI assigned

Oct 10, 2019

Last updated

Dec 17, 2024By the provider in NPPES

Sex

Male

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Birch Tree Communities IncGroup PAC ID 5597749747, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Birch Tree Communities Inc

  dba Conway Branch

  • Community/Behavioral Health Agency
  • Conway, AR
  • NPI 1770733768
  Medicare reassignment Care Compare group NPD
• Birch Tree Communities, Inc

  dba Clinton Branch

  • Community/Behavioral Health Agency
  • Clinton, AR
  • NPI 1629228606
  NPD
• Birch Tree Communities, Inc

  dba Clarksville Branch - Phoenix Center

  • Community/Behavioral Health Agency
  • Clarksville, AR
  • NPI 1770873499
  NPD

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1114569118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1589",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720181589",
            "telephone_number": "501-315-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1628 E PAGE AVE",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721044524",
            "telephone_number": "501-315-3344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JORDAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-10",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desiree Skeya
• Madilyn Slagle
• Abrigail Smith
• Bailey Michele Smith
• Griffin Smith, O.D.
• Nicole Smith, RN
• Rebecca Smith
• Sasha Smith, RECOVERY ADVOCATE
• Teresa Smith, MHPP
• Source Therapy Solutions PLLC

• Mental Health Counselor in Malvern, AR
• Providers in Malvern, 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 Dec 17, 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.