Provider Demographics
NPI:1902352115
Name:PARSONS, CORY (LAC)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:PARSONS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-3724
Mailing Address - Country:US
Mailing Address - Phone:479-705-1634
Mailing Address - Fax:479-705-1635
Practice Address - Street 1:1310 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2803
Practice Address - Country:US
Practice Address - Phone:479-968-2001
Practice Address - Fax:479-705-1635
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2102210101YM0800X
ARP2211006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR223085795Medicaid
AR5B266Medicare PIN