Provider Demographics
NPI:1316278120
Name:PARKS, VICKY LEE (LPC)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:LEE
Last Name:PARKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1374 HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-3790
Mailing Address - Country:US
Mailing Address - Phone:833-743-2546
Mailing Address - Fax:870-202-2077
Practice Address - Street 1:111 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2634
Practice Address - Country:US
Practice Address - Phone:870-598-0306
Practice Address - Fax:870-598-0328
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR182663795Medicaid
AR5YY03OtherBCBS