Healthcare Provider Details

I. General information

NPI: 1336536937
Provider Name (Legal Business Name): STEVEN VAN PARKER LPC, HI, DS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 MAIN AVE S
TWIN FALLS ID
83301-6232
US

IV. Provider business mailing address

264 MAIN AVE S
TWIN FALLS ID
83301-6232
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-0407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6421
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: