Healthcare Provider Details

I. General information

NPI: 1447904545
Provider Name (Legal Business Name): THOMAS PARKER LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W WALNUT ST STE B1100
ROGERS AR
72756-3562
US

IV. Provider business mailing address

PO BOX 679
MORRILTON AR
72110-0679
US

V. Phone/Fax

Practice location:
  • Phone: 479-278-7028
  • Fax: 479-278-2092
Mailing address:
  • Phone: 150-135-4458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9538
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: