Shangaleza Benton, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A1909130 Issued in AR

Practice address

3111 S 70TH St
Fort Smith, AR 72903-5017

Phone

(479) 452-6650

Fax

(479) 452-5847

NPI assigned

Dec 6, 2017

Last updated

Dec 10, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grand Lake Mental Health Center, Inc.

  dba GRAND Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, OK
  • NPI 1497762520
  Medicare reassignment NPD
• Grand Lake Mental Health Center, Inc.

  dba GRAND Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Afton, OK
  • NPI 1316954431
  NPD
• Grand Lake Mental Health Center, Inc.

  dba Grand Mental Health

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1356048656
  NPD

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

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1982119384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11818",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729171818",
            "telephone_number": "479-452-6650",
            "fax_number": "479-452-5847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 S 70TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035017",
            "telephone_number": "479-452-6650",
            "fax_number": "479-452-5847"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2153 E Joyce Blvd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727035285",
            "country_code": "US",
            "telephone_number": "479-575-9471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENTON",
        "first_name": "SHANGALEZA",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-06",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A1909130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ann Bennett, APRN
• Jordan Bennett, RBT
• Emily Christine Benoit, M.S CCC-SLP
• Martha Gwen Benson
• Sara Benton, CIT
• Eric Berg
• Holly Danielle Bernard, RD, LD, CDE
• Shawn Berry, MHPP
• Mike Berumen, MD
• Valerie Beshears, DNP, RN

• Mental Health Counselor in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.