Active NPI
Jessica Ims
- Mental Health Counselor
- Fayetteville, AR
National Provider Identifier
1598457475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A2212010
- Practice address
- 34 W Colt Square Dr Ste 3
Fayetteville, AR 72703-2888 - Phone
- (479) 595-0333
- NPI assigned
- May 22, 2023
- 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 | A2212010 | AR | Primary |
Addresses
Primary practice location
34 W Colt Square Dr Ste 3
Fayetteville, AR 72703-2888
Mailing address
13935 Pyramid Dr
Rogers, AR 72758-7527
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 30, 2025 through Sep 30, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A2212010 | AR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684713600000",
"number": "1598457475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13935 PYRAMID DR",
"city": "ROGERS",
"state": "AR",
"postal_code": "727587527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 W COLT SQUARE DR STE 3",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727032888",
"telephone_number": "479-595-0333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMS",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-22",
"last_updated": "2023-05-22",
"certification_date": "2023-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AR",
"license": "A2212010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.