Provider Demographics
NPI:1821305186
Name:FORT SMITH BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:FORT SMITH BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CHIOVOLONI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, SAP, LADAC,
Authorized Official - Phone:479-494-7889
Mailing Address - Street 1:1620 S 46TH ST
Mailing Address - Street 2:1620 S 46TH STREET
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3129
Mailing Address - Country:US
Mailing Address - Phone:479-494-7889
Mailing Address - Fax:479-494-7890
Practice Address - Street 1:1620 S 46TH ST
Practice Address - Street 2:1620 S 46TH STREET
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3129
Practice Address - Country:US
Practice Address - Phone:479-494-7889
Practice Address - Fax:479-494-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR02511101YA0400X
AR2295-CP1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR203767OtherICAADC
AR400690OtherICCDPD
AR023OtherCCDP
ARA-289OtherAADC
AR2295-CPOtherLCSW
AR02511OtherLADAC
AR13288OtherSAP