Healthcare Provider Details

I. General information

NPI: 1548488711
Provider Name (Legal Business Name): JEREMY PHILLIP DUCKER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 HIGHWAY 69 BLVD
TRUMANN AR
72472-2029
US

IV. Provider business mailing address

1815 PLEASANT GROVE RD
JONESBORO AR
72401-7870
US

V. Phone/Fax

Practice location:
  • Phone: 870-483-4003
  • Fax: 870-483-4009
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1403027
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: