Individual provider Active NPI

Jessica Reed, LCSW

  • Clinical Social Worker
  • Springdale, AR
National Provider Identifier
1932687274
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11193-C Issued in AR
Practice address
614 E Emma Ave Ste 300
Springdale, AR 72764-4469
Phone
(479) 751-7417
Fax
(479) 751-4898
NPI assigned
Jul 30, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X 11193-C AR Primary

Addresses

Primary practice location

614 E Emma Ave Ste 300
Springdale, AR 72764-4469

Mailing address

614 E Emma Ave Ste 300
Springdale, AR 72764-4469
Phone (479) 751-7417

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20210108001455 OK Practitioner - Clinical Social Worker 2668885716 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

111 E 12TH St
Ada, OK 74820-6501
Phone (580) 436-2690

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7676OKMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lighthouse Behavioral Wellness Centers CurrentSince Jan 19, 2025 Accepting new patients
Lighthouse Behavioral Wellness Centers CurrentSince Jan 19, 2025 Accepting new patients

Locations

111 E 12th St
Ada, OK 74820
Phone (580) 436-2690

2530 S Commerce St
Bldg B
Ardmore, OK 73401
Phone (580) 319-7305

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.

NPI Registry JSON

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

{
    "created_epoch": "1532908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1932687274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 E EMMA AVE STE 300",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644469",
            "telephone_number": "479-751-7417",
            "fax_number": "479-751-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 E EMMA AVE STE 300",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644469",
            "telephone_number": "479-751-7417",
            "fax_number": "479-751-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REED",
        "first_name": "JESSICA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-30",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "11193-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springdale, AR

Sources for this page

Verify at the official NPI Registry.