Summer Nicole Bader, LPC
Individual provider Active NPI Professional Counselor · Paragould, AR
NPI 1184907313 · NPPES record last updated May 9, 2018
Key facts
- NPI
- 1184907313
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- P1307077 (AR)
- Practice address
- 1101 Morgan St
Suite 8
Paragould, AR 72450-3949 - Phone
- (870) 335-9483
- Fax
- (870) 335-9487
- NPI assigned
- Sep 23, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240131002454 | AR | Practitioner - Mental Health Counselor | 9032568316 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Families, Inc. of Arkansas | Current |
Accepting new patients | |
| Families, Inc of Arkansas | Mental Health | Current |
Accepting new patients |
| Families, Inc. of Arkansas | Mental Health | Past | Accepting new patients |
| Families, Inc. of Arkansas | Mental Health | Past | Accepting new patients |
Locations
1815 Pleasant Grove Rd
Jonesboro, AR 72405
Phone (870) 833-6886
1101 W Morgan St
Ste 8
Paragould, AR 72450
Phone (870) 335-9483
1425 W Main St
Walnut Ridge, AR 72476
Phone (870) 886-5303
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | P1307077 | AR | |
| Professional Counselor | 101YP2500X | P1307077 | AR | Yes |
Addresses
Primary practice location
1101 Morgan St
Suite 8
Paragould, AR 72450-3949
Mailing address
1815 Pleasant Grove Rd
Jonesboro, AR 72401-7870
Phone (870) 933-6886
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180732795 | Medicaid | AR | |
| 5UU79 | Other | AR | BCBS |
Other providers in Paragould, AR
- Aspire Medical PLLC
- Christy Nicole Austin
- Kyley Austin
- Tabatha Austin
- Jonathan Gerald Bachelor
- Charlena Dian Bagwell
- Angela Christine Bailey
- Deanna M Bailey
- Natasha Lee Bailey
- Rebekka Leah Bailey
All providers in Paragould, AR · Professional Counselor in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.