Basic Information
Provider Information | |||||||||
NPI: | 1518424472 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALBERT | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LAC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VINSON | ||||||||
OtherFirstName: | SARAH | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1589 | ||||||||
Address2: |   | ||||||||
City: | BENTON | ||||||||
State: | AR | ||||||||
PostalCode: | 720181589 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5013153344 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6701 HIGHWAY 67 BLDG 4 | ||||||||
Address2: |   | ||||||||
City: | BENTON | ||||||||
State: | AR | ||||||||
PostalCode: | 72015 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5013153344 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/27/2019 | ||||||||
LastUpdateDate: | 11/09/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/09/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A1902021 | AR | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | P2211000 | AR | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.