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2020 E Joyce Blvd Fayetteville AR 72703-6254 | |
| (479) 332-4557 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 2020 E Joyce Blvd, Fayetteville, Arkansas |
| Authorized Official Name and Position | Virginia Marie Steelman (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7045066267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11000 Optum Cir Eden Prairie MN 55344-2503 Ph: (479) 332-4557 | 2020 E Joyce Blvd Fayetteville AR 72703-6254 Ph: (479) 332-4557 |
| NPI Number | 1639944960 |
|---|---|
| Provider Enumeration Date | 11/16/2023 |
| Last Update Date | 03/13/2024 |
| Certification Date | 03/13/2024 |
| Medicare PECOS PAC ID | 5092120030 |
|---|---|
| Medicare Enrollment ID | O20240618000951 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639944960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Ashley E Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437121373 PECOS PAC ID: 4789698549 Enrollment ID: I20060131000811 |
| Provider Name | Ilo Webster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962651794 PECOS PAC ID: 7517391162 Enrollment ID: I20200107002333 |
| Provider Name | Brooke Bell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912577099 PECOS PAC ID: 7113377011 Enrollment ID: I20231219000194 |
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