NPIMap

Organization Active NPI

Counseling Clinic, Inc

  • Psychiatry Physician
  • Benton, AR
National Provider Identifier
1649267659
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
COUNSELING CLINIC, INC
Practice address
110 Pearson
Benton, AR 72015-4436
Phone
(501) 315-4224
Fax
(501) 778-0450
NPI assigned
Oct 4, 2005
Last updated
Aug 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Authorized official

Name
Robert Bennett, LCSWNPI 1467778175
Title
Ceo
Phone
(501) 315-4224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

110 Pearson
Benton, AR 72015-4436

Mailing address

110 Pearson
Benton, AR 72015-4436
Phone (501) 315-4224

Other identifiers 1

IdentifierTypeStateIssuer
116381726MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050114000834 AR Part B Supplier - Clinic/Group Practice 6204885304 Receives reassigned benefits from 43 practitioners
1 other NPI on this enrollment
Practice locations: Benton, AR; Hot Springs, AR

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2246604Counseling Clinic Inc110 Pearson St, Benton, AR 72015Certificate of waiverDec 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Counseling Clinic Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

112 Pearson
Benton, AR 72015
Phone (501) 315-4224

Practitioners & affiliated clinicians

Practitioners 54

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1649267659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 PEARSON",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154436",
            "telephone_number": "501-315-4224",
            "fax_number": "501-778-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PEARSON",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154436",
            "telephone_number": "501-315-4224",
            "fax_number": "501-778-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNSELING CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "501-315-4224",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116381726",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.