Provider Demographics
NPI:1659521771
Name:IRVIN, RICHARD WAYNE II (LPN, MHPP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WAYNE
Last Name:IRVIN
Suffix:II
Gender:M
Credentials:LPN, MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 BLEAUX AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0737
Mailing Address - Country:US
Mailing Address - Phone:479-872-5580
Mailing Address - Fax:479-872-5581
Practice Address - Street 1:1817 WOODSPRINGS RD
Practice Address - Street 2:STE G
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-0903
Practice Address - Country:US
Practice Address - Phone:870-934-9800
Practice Address - Fax:870-934-8463
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL45386101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor