Individual provider Active NPI

Valisya Coleman, LCSW

  • Clinical Social Worker
  • Wynne, AR
National Provider Identifier
1679046098
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
204 Mississippi St S
Wynne, AR 72396-3025
Phone
(870) 208-8499
Fax
(870) 208-8044
NPI assigned
Jan 8, 2019
Last updated
Apr 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X AR Primary

Addresses

Primary practice location

204 Mississippi St S
Wynne, AR 72396-3025

Mailing address

204 Mississippi St S
Wynne, AR 72396-3025
Phone (870) 208-8499

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250501000738 AR Practitioner - Clinical Social Worker 0749706893 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
May accept Medicare assignment
Group practices
Changes Behavioral Health, LLCGroup PAC ID 6103149653, 8 clinicians

Practice addresses (Care Compare)

204 Mississippi St S
Wynne, AR 72396-3025
Phone (870) 208-8499

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Changes Behavioral Health, LLC CurrentSince Apr 15, 2025 Accepting new patients

Locations

204 Mississippi St S
Wynne, AR 72396
Phone (870) 208-8499

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1679046098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MISSISSIPPI ST S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963025",
            "telephone_number": "870-208-8499",
            "fax_number": "870-587-0576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MISSISSIPPI ST S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963025",
            "telephone_number": "870-208-8499",
            "fax_number": "870-208-8044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "VALISYA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-08",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wynne, AR

Sources for this page

Verify at the official NPI Registry.