Active NPI
Sidney Icenhower
- Mental Health Counselor
- Russellville, AR
National Provider Identifier
1750234845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A2602019
- Practice address
- 1310 W Main St Ste 100
Russellville, AR 72801-2803 - Phone
- (479) 968-2001
- NPI assigned
- Feb 18, 2026
- Last updated
- Feb 18, 2026
- 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 | A2602019 | AR | Primary |
Addresses
Primary practice location
1310 W Main St Ste 100
Russellville, AR 72801-2803
Mailing address
1310 W Main St Ste 201
Russellville, AR 72801-2803
Phone (479) 968-2001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A2602019 | AR | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Real Development Corporation | Past | Accepting new patients |
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.
-
dba RPI Behavioral Health
- Community/Behavioral Health Agency
- Russellville, AR
- NPI 1568943140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1771372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771372800000",
"number": "1750234845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1310 W MAIN ST STE 201",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728012803",
"telephone_number": "479-968-2001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 W MAIN ST STE 100",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728012803",
"telephone_number": "479-968-2001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICENHOWER",
"first_name": "SIDNEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-02-18",
"last_updated": "2026-02-18",
"certification_date": "2026-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AR",
"license": "A2602019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.