| Fort Smith Behavioral Health Inc | |
|
1620 S 46th St 1620 S 46th Street Fort Smith AR 72903-3129 | |
| (479) 494-7889 | |
| (479) 494-7890 |
| Full Name | Fort Smith Behavioral Health Inc |
|---|---|
| Speciality | Social Worker |
| Location | 1620 S 46th St, Fort Smith, Arkansas |
| Authorized Official Name and Position | Stephen Douglas Chiovoloni (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 4794947889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Smith Behavioral Health Inc 1620 S 46th St 1620 S 46th Street Fort Smith AR 72903-3129 Ph: (479) 494-7889 | Fort Smith Behavioral Health Inc 1620 S 46th St 1620 S 46th Street Fort Smith AR 72903-3129 Ph: (479) 494-7889 |
| NPI Number | 1821305186 |
|---|---|
| Provider Enumeration Date | 09/08/2010 |
| Last Update Date | 08/11/2014 |
| Medicare PECOS PAC ID | 3072789528 |
|---|---|
| Medicare Enrollment ID | O20120104000496 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821305186 | NPI | - | NPPES |
| 203767 | Other | AR | ICAADC |
| 400690 | Other | AR | ICCDPD |
| 023 | Other | AR | CCDP |
| A-289 | Other | AR | AADC |
| 2295-CP | Other | AR | LCSW |
| 02511 | Other | AR | LADAC |
| 13288 | Other | AR | SAP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 02511 (Arkansas) | Secondary |
| 1041C0700X | Social Worker - Clinical | 2295-CP (Arkansas) | Primary |
| Provider Name | Stephen D Chiovoloni |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316957830 PECOS PAC ID: 2860557329 Enrollment ID: I20090217000233 |
| Provider Name | Ashley Mozelle Mckenzie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669935870 PECOS PAC ID: 6406257088 Enrollment ID: I20210702001898 |
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