Healthcare Provider Details

I. General information

NPI: 1679029201
Provider Name (Legal Business Name): ARIC BOKKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 HIGHWAY 62 412
HIGHLAND AR
72542-9477
US

IV. Provider business mailing address

PO BOX 176
CHEROKEE VILLAGE AR
72525-0176
US

V. Phone/Fax

Practice location:
  • Phone: 870-856-3337
  • Fax: 870-856-3334
Mailing address:
  • Phone: 870-257-3336
  • Fax: 870-257-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1901006
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: