Provider Demographics
NPI:1851937171
Name:PARKER, CHEYENNE (LPC)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 S 51ST CT STE G
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3666
Mailing Address - Country:US
Mailing Address - Phone:479-323-2424
Mailing Address - Fax:479-226-3133
Practice Address - Street 1:2408 S 51ST CT STE G
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3666
Practice Address - Country:US
Practice Address - Phone:479-322-1095
Practice Address - Fax:479-226-3133
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2208020101YP2500X
ARA1910155101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor