Provider Demographics
NPI:1306147806
Name:PARKE, ROBERT DANIEL JR (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DANIEL
Last Name:PARKE
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:ROB
Other - Middle Name:
Other - Last Name:PARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:2400 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6683
Mailing Address - Country:US
Mailing Address - Phone:479-750-2020
Mailing Address - Fax:479-750-4843
Practice Address - Street 1:208 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-8872
Practice Address - Country:US
Practice Address - Phone:479-750-2020
Practice Address - Fax:479-750-4843
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1011130101YM0800X
ARP1607067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184022795Medicaid