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12106 Highway 71 S Ste A Fort Smith AR 72916-8405 | |
| (479) 431-8152 | |
| (855) 315-2928 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 12106 Highway 71 S Ste A, Fort Smith, Arkansas |
| Authorized Official Name and Position | Lisa Albuja (LPC) |
| Authorized Official Contact | 4794318152 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1401 S Waldron Rd Ste 200 Fort Smith AR 72903-2590 Ph: (479) 431-8152 | 12106 Highway 71 S Ste A Fort Smith AR 72916-8405 Ph: (479) 431-8152 |
| NPI Number | 1952762866 |
|---|---|
| Provider Enumeration Date | 03/19/2016 |
| Last Update Date | 09/18/2024 |
| Certification Date | 09/18/2024 |
| Medicare PECOS PAC ID | 8123568615 |
|---|---|
| Medicare Enrollment ID | O20240911001412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952762866 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | A1603031 (Arkansas) | Secondary |
| 101YP2500X | Counselor - Professional | P1506065 (Arkansas) | Primary |
| Provider Name | Gary R Greenwood |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942236047 PECOS PAC ID: 1850741950 Enrollment ID: I20240102003566 |
| Provider Name | Lisa Albuja |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730437526 PECOS PAC ID: 8921548413 Enrollment ID: I20241004000009 |
| Provider Name | Pablo Ruben Albuja |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861855769 PECOS PAC ID: 5991236606 Enrollment ID: I20241007000081 |
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