Active NPI
Angelic M Otis
- Mental Health Counselor
- Hope, AR
National Provider Identifier
1750828562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A2207003
- Practice address
- 114 Medical Park Dr
Hope, AR 71801-8100 - Phone
- (870) 474-5001
- NPI assigned
- Jan 31, 2017
- 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 | A2207003 | AR | Primary |
Addresses
Primary practice location
114 Medical Park Dr
Hope, AR 71801-8100
Mailing address
114 Medical Park Dr
Hope, AR 71801-8100
Phone (870) 474-5001
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 |
|---|---|---|---|
| A2207003 | AR | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arkansas Counseling and Psychodiagnostics, Inc. | Past | Accepting new patients | |
| Arkansas Counseling and Psychodiagnostics, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Adolescent and Children Mental Health Clinic/Center
- Arkadelphia, AR
- NPI 1356838569
-
- Adolescent and Children Mental Health Clinic/Center
- Arkadelphia, AR
- NPI 1902060684
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670976000000",
"number": "1750828562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 MEDICAL PARK DR",
"city": "HOPE",
"state": "AR",
"postal_code": "718018100",
"telephone_number": "870-474-5001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 MEDICAL PARK DR",
"city": "HOPE",
"state": "AR",
"postal_code": "718018100",
"telephone_number": "870-474-5001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTIS",
"first_name": "ANGELIC",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-31",
"last_updated": "2022-12-14",
"certification_date": "2022-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AR",
"license": "A2207003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hope, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.