Provider Demographics
NPI:1952525685
Name:FORT SMITH PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:FORT SMITH PUBLIC SCHOOLS
Other - Org Name:SCHOOL BASED MENTAL HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:SPECIAL ED SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-785-2501
Mailing Address - Street 1:PO BOX 1948
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72902-1948
Mailing Address - Country:US
Mailing Address - Phone:479-785-2501
Mailing Address - Fax:479-709-6059
Practice Address - Street 1:3205 JENNY LIND RD
Practice Address - Street 2:BUILDING D
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7101
Practice Address - Country:US
Practice Address - Phone:479-785-2501
Practice Address - Fax:479-709-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR97-8E101YM0800X
AR88-12E101YM0800X
AR86-3E101YM0800X
AR76-16E101YM0800X
ARP0011035101YM0800X
AR98-07E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158216791Medicaid