Individual provider Active NPI

Ellen Bennett

  • Mental Health Counselor
  • Springdale, AR
National Provider Identifier
1306629258
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
3623 Johnson Mill Blvd Ste 103
Springdale, AR 72762-6412
Phone
(479) 435-4207
Fax
(479) 935-3180
NPI assigned
Aug 15, 2023
Last updated
Aug 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

3623 Johnson Mill Blvd Ste 103
Springdale, AR 72762-6412

Mailing address

PO Box 9541
Fayetteville, AR 72703-0026
Phone (479) 435-4207

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
I20260504006499 AR Practitioner - Mental Health Counselor 8123596673 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3623 Johnson Mill Blvd
Suite 103
Springdale, AR 72762-6328

PO Box
Suite 9541
Fayetteville, AR 72703-0026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Eason Counseling and Associates, LLC CurrentSince Aug 27, 2023 Accepting new patients

Organizations & group practices 1

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": "1692057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1306629258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9541",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727030026",
            "telephone_number": "479-435-4207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 JOHNSON MILL BLVD STE 103",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727626412",
            "telephone_number": "479-435-4207",
            "fax_number": "479-935-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "ELLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-15",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springdale, AR

Sources for this page

Verify at the official NPI Registry.