Active NPI
Misti Lynne Poulos, LPC
- Professional Counselor
- Springdale, AR
National Provider Identifier
1508097858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- P2101143
- Practice address
- 471 Doris
Springdale, AR 72762-4151 - Phone
- (214) 632-4707
- NPI assigned
- Aug 4, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 | P2101143 | AR | Primary |
Addresses
Primary practice location
471 Doris
Springdale, AR 72762-4151
Mailing address
471 Doris
Springdale, AR 72762-4151
Phone (214) 632-4707
Other practice location 1
4534 Stanley Ave
#361
Fort Worth, TX 76115
Phone (214) 632-4707
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Springdale | Direct |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P2101143 | AR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| WH Ar Medical PLLC | Single Specialty | Past | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613433600000",
"number": "1508097858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "471 DORIS",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "727624151",
"telephone_number": "214-632-4707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "471 DORIS",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "727624151",
"telephone_number": "214-632-4707"
}
],
"practiceLocations": [
{
"address_1": "4534 Stanley Ave",
"address_2": "#361",
"address_purpose": "LOCATION",
"city": "Fort Worth",
"state": "TX",
"postal_code": "76115",
"country_code": "US",
"telephone_number": "214-632-4707",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "POULOS",
"first_name": "MISTI",
"middle_name": "LYNNE",
"name_prefix": "Dr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-04",
"last_updated": "2021-02-16",
"certification_date": "2021-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "AR",
"license": "P2101143",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Springdale",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "471 Doris",
"city": "Springdale",
"state": "AR",
"country_code": "US",
"postal_code": "727624151",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Springdale, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.