Jason Waller, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P2108017 Issued in AR

Practice address

3634 Central Ave Ste a
Hot Springs, AR 71913-6472

Phone

(501) 547-3763

NPI assigned

Dec 21, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Harbor House Incorporated of Fort Smith Arkansas 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Harbor House Incorporated of Fort Smith Arkansas

  • Substance Abuse Rehabilitation Facility
  • Fort Smith, AR
  • NPI 1922166123

  AR, Single Specialty

  Medicare reassignment Care Compare group NPD
• Shiloh'S Counseling and Wellness LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hot Springs, AR
  • NPI 1346904331
  NPD Authorized official
• Refresh in-Home Counseling LLC

  • Clinical Social Worker
  • Antioch, IL
  • NPI 1609365519

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1292889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1780987362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3634 CENTRAL AVE STE A",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719136472",
            "telephone_number": "501-547-3763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3634 CENTRAL AVE STE A",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719136472",
            "telephone_number": "501-547-3763"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106B Shadow Peak Ln",
            "address_purpose": "LOCATION",
            "city": "Hot Springs",
            "state": "AR",
            "postal_code": "719132376",
            "country_code": "US",
            "telephone_number": "501-655-6483",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JASON",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-12-21",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "AR",
            "license": "A1708247",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "P2108017",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "AR",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P2108017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC",
            "identifier": "P2108017",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jason@shilohscounselingandwellness.com",
            "affiliation": "N",
            "endpointDescription": "Owner / manager primary email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3634 Central Ave Ste A",
            "city": "Hot Springs",
            "state": "AR",
            "country_code": "US",
            "postal_code": "719136472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wallace W. Towle, OD PA
• Brandy Wallace, QBHP
• Fannie Beatrice Wallace, LPC
• Morgan Alita Wallace, LCSW
• Thomas R Wallace, M.D.
• Luther Rhett Walley, M.D.
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.

• All providers in Hot Springs, AR
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.