Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 2005040310 | MO |
Y | 101YP2500X | Professional Counselor |
NPI | 1003841115 |
---|---|
Provider Name | Mrs. Heather Renee Parker |
First Address | Jonesboro, AR 72401-7213 |
Second Address | Jonesboro, AR 72401-7213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 06/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11819662 | CAQH (01) | |
497576207 | (05) | MO |