Blue Serenity Therapy LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

BLUE SERENITY THERAPY LLC

Practice address

15 Pamela LN
Sherwood, AR 72120-2645

Phone

(501) 944-4660

NPI assigned

Jan 14, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robin Michelle Jackson, LCSWNPI 1912212705

Title

Owner

Phone

(501) 944-4660

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robin Michelle Jackson, LCSW

  • Clinical Social Worker
  • Sherwood, AR
  • NPI 1912212705

  Mental Health

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738540800000",
    "number": "1649081332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PAMELA LN",
            "city": "SHERWOOD",
            "state": "AR",
            "postal_code": "721202645",
            "telephone_number": "501-944-4660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PAMELA LN",
            "city": "SHERWOOD",
            "state": "AR",
            "postal_code": "721202645",
            "telephone_number": "501-944-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE SERENITY THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-14",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-944-4660",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Leanne Bingham, ST
• Biomolecular Integrations Inc
• Susan Renee Blagg, OTR/L
• Eleanor Blakely, RBT
• Callie Rose Bland, RBT
• Sandra Elizabeth Boatman, M.A., CCC-SLP
• Jada Andrea Bolden
• Carissa Alana Bone, LPC
• Elysa Bonner
• Renita W Booker

• Mental Health Counselor in Sherwood, AR
• Providers in Sherwood, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.