Provider Demographics
NPI:1770152043
Name:WENDELL E. SMITH COUNSELING, INC.
Entity type:Organization
Organization Name:WENDELL E. SMITH COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:870-926-7356
Mailing Address - Street 1:422 W HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5816
Mailing Address - Country:US
Mailing Address - Phone:870-926-7356
Mailing Address - Fax:
Practice Address - Street 1:1809 EXECUTIVE SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6086
Practice Address - Country:US
Practice Address - Phone:870-926-7356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1215104740Medicaid