Provider Demographics
NPI:1518992163
Name:BOKKER, LON PAUL SR (LPC PHD)
Entity Type:Individual
Prefix:
First Name:LON
Middle Name:PAUL
Last Name:BOKKER
Suffix:SR
Gender:M
Credentials:LPC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72525
Mailing Address - Country:US
Mailing Address - Phone:870-257-3336
Mailing Address - Fax:870-257-3339
Practice Address - Street 1:#4 EAST CHEROKEE VILLAGE MALL
Practice Address - Street 2:
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529
Practice Address - Country:US
Practice Address - Phone:870-257-3336
Practice Address - Fax:870-257-3339
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X919OtherBLUECROSS PROVIDER NUMBER