Active NPI
Holly Gilliam, LPC
- Professional Counselor
- Fort Smith, AR
National Provider Identifier
1497415707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- P2202016
- Practice address
- 3111 S 70TH St
Fort Smith, AR 72903-5017 - Phone
- (479) 452-6650
- Fax
- (479) 452-5847
- NPI assigned
- Dec 28, 2021
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | P2202016 | AR | Primary |
Addresses
Primary practice location
3111 S 70TH St
Fort Smith, AR 72903-5017
Mailing address
PO Box 11818
Fort Smith, AR 72917-1818
Phone (479) 452-6650
Other names 1
- Holly Bearden
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 |
|---|---|---|---|
| P2202016 | AR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mustard Seed | Mental Health | Current | 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 and National Provider Directory roles.
-
- Mental Health Counselor
- Greenwood, AR
- NPI 1649010026
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670889600000",
"number": "1497415707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11818",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729171818",
"telephone_number": "479-452-6650",
"fax_number": "479-452-5847"
},
{
"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": "479-452-5847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIAM",
"first_name": "HOLLY",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-28",
"last_updated": "2022-12-13",
"certification_date": "2022-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AR",
"license": "P2202016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "HOLLY",
"last_name": "BEARDEN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fort Smith, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.