Active NPI
Misty Leanne Juola, LPE
- Mental Health Counselor
- Benton, AR
National Provider Identifier
1417175159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 01-21E
- Practice address
- 109 W South St.
Aca
Benton, AR 72015 - Phone
- (501) 776-1191
- Fax
- (501) 776-1194
- NPI assigned
- Apr 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 01-21E | AR | Primary |
Addresses
Primary practice location
109 W South St.
Aca
Benton, AR 72015
Mailing address
109 W South St.
Aca - Arkansas Counseling Assocciates
Benton, AR 72015
Phone (501) 776-1191
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5Y529 | Other | AR | BCBS |
Other names 1
- Mrs. Misty E Witherington
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01-21E | AR | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maxus Inc. | Mental Health | Past | Accepting new patients |
| Maxus Inc | Mental Health | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402963200000",
"number": "1417175159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 W SOUTH ST.",
"address_2": "ACA - ARKANSAS COUNSELING ASSOCCIATES",
"city": "BENTON",
"state": "AR",
"postal_code": "72015",
"telephone_number": "501-776-1191",
"fax_number": "501-776-1194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 W SOUTH ST.",
"address_2": "ACA",
"city": "BENTON",
"state": "AR",
"postal_code": "72015",
"telephone_number": "501-776-1191",
"fax_number": "501-776-1194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUOLA",
"first_name": "MISTY",
"middle_name": "LEANNE",
"name_prefix": "Mrs.",
"credential": "LPE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-20",
"last_updated": "2014-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AR",
"license": "01-21E",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "5Y529",
"state": "AR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MISTY",
"last_name": "WITHERINGTON",
"middle_name": "E",
"prefix": "MRS.",
"credential": "LPE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Benton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.