Active NPI
Melinda Diane Jewell, LPC
- Professional Counselor
- Texarkana, AR
National Provider Identifier
1558540484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- P0903019
- Practice address
- 3220 Jewell St
Texarkana, AR 71854-5815 - Phone
- (870) 729-1212
- Fax
- (870) 729-1223
- NPI assigned
- Oct 27, 2007
- Last updated
- Oct 12, 2020
- 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 | P0903019 | AR | Primary |
Addresses
Primary practice location
3220 Jewell St
Texarkana, AR 71854-5815
Mailing address
3220 Jewell St
Texarkana, AR 71854-5815
Phone (870) 729-1212
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250219003970 | AR | Practitioner - Mental Health Counselor | 1759801889 | Practice locations: Texarkana, AR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P0903019 | AR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602460800000",
"number": "1558540484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3220 JEWELL ST",
"city": "TEXARKANA",
"state": "AR",
"postal_code": "718545815",
"telephone_number": "870-729-1212",
"fax_number": "870-729-1223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3220 JEWELL ST",
"city": "TEXARKANA",
"state": "AR",
"postal_code": "718545815",
"telephone_number": "870-729-1212",
"fax_number": "870-729-1223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEWELL",
"first_name": "MELINDA",
"middle_name": "DIANE",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-27",
"last_updated": "2020-10-12",
"certification_date": "2020-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AR",
"license": "P0903019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Texarkana, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.