NPIMap

Organization Active NPI

Foundation: a Wellness Practice, LLC

  • Counselor
  • Jonesboro, AR
National Provider Identifier
1750878203
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
FOUNDATION: A WELLNESS PRACTICE, LLC
Practice address
533 W Washington Ave
Jonesboro, AR 72401
Phone
(870) 229-0302
Fax
(870) 520-6482
NPI assigned
Apr 20, 2018
Last updated
Sep 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

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

Authorized official

Name
Mrs. Vicki Lanell White, LCSWNPI 1134248164
Title
Owner
Phone
(573) 344-0976

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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Mental Health Counselor 101YM0800X NU
Professional Counselor 101YP2500X NU
Clinical Psychologist 103TC0700X NU
Counseling Psychologist 103TC1900X NU
Behavior Analyst 103K00000X NU

Addresses

Primary practice location

533 W Washington Ave
Jonesboro, AR 72401

Mailing address

533 W Washington Ave
Jonesboro, AR 72401-2782
Phone (870) 229-0302

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190103002743 AR Part B Supplier - Clinic/Group Practice 2668718172 Receives reassigned benefits from 11 practitioners
Practice locations: Jonesboro, AR

National Provider Directory

National Provider Directory

Locations

533 W Washington Ave
Jonesboro, AR 72401
Phone (870) 229-0302

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1524182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538092800000",
    "number": "1750878203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "533 W WASHINGTON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724012782",
            "telephone_number": "870-229-0302",
            "fax_number": "870-520-6482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 W WASHINGTON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "870-229-0302",
            "fax_number": "870-520-6482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATION: A WELLNESS PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-20",
        "last_updated": "2018-09-28",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "LANELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-344-0976",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2018; 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.