Provider Demographics
NPI:1831808294
Name:RUCKER, JONATHAN (LPC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:RUCKER
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13767 PELLA LN
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-8781
Mailing Address - Country:US
Mailing Address - Phone:479-368-2911
Mailing Address - Fax:479-391-5254
Practice Address - Street 1:2703 SE G ST STE 2
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3740
Practice Address - Country:US
Practice Address - Phone:479-368-2911
Practice Address - Fax:479-391-5254
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2404003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional