Provider Demographics
NPI:1063620243
Name:REVA PARKER, RN, LCPC, P.C.
Entity type:Organization
Organization Name:REVA PARKER, RN, LCPC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REVA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-586-3308
Mailing Address - Street 1:2050 FAIRWAY DR
Mailing Address - Street 2:#208
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRWAY DR
Practice Address - Street 2:#208
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5871
Practice Address - Country:US
Practice Address - Phone:406-586-3308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC #365106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty