Andrew Donovan, LAC
Individual provider Active NPI Professional Counselor · Benton, AR
NPI 1972043792 · NPPES record last updated Jan 12, 2022
Key facts
- NPI
- 1972043792
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- P2110003 (AR)
- Practice address
- 1502 Mary Kay Blvd
Benton, AR 72015 - Phone
- (501) 315-3344
- NPI assigned
- Feb 27, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Birch Tree Communities Inc
Practice addresses (Care Compare)
1502 Mary Kay Blvd
Benton, AR 72015-0001
Phone (501) 315-3344
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240106000649 | AR | Practitioner - Mental Health Counselor | 1658722343 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A1810152 | AR | MD | Counselor |
| P2110003 | AR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Birch Tree Communities, Inc | Current |
Accepting new patients | |
| Birch Tree Communities Inc | Current | Accepting new patients | |
| Birch Tree Communities, Inc | Current |
Accepting new patients |
Locations
1506 Mary Kay Blvd
Benton, AR 72015
Phone (501) 303-1665
1718 Hot Springs Hwy
Benton, AR 72019
Phone (501) 303-1634
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | A1810152 | AR | |
| Case Manager/Care Coordinator | 171M00000X | |||
| Professional Counselor | 101YP2500X | P2110003 | AR | Yes |
Addresses
Primary practice location
1502 Mary Kay Blvd
Benton, AR 72015
Mailing address
PO Box 1589
Benton, AR 72018-1589
Phone (501) 315-3344
Other practice location 1
3715 N Business Dr Ste 104
Fayetteville, AR 72703-5287
Phone (479) 575-9471 ext. 35012
Other providers in Benton, AR
- Tywan Dobbins
- Kristina M Dodson Dupree
- Pamela Diane Dodson
- Whitney Donahue
- Joseph Donnelly
- Carolyn Dotson
- Adrienne Leigh Douglas
- Susan Douglas
- Dr Q Pain & Spine Clinic, PA
- Dream Big Pediatric Therapies
All providers in Benton, AR · Professional Counselor in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.