Provider Demographics
NPI:1932387016
Name:PRIEST, JON (LPE)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:PRIEST
Suffix:
Gender:M
Credentials:LPE
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 344
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-0344
Mailing Address - Country:US
Mailing Address - Phone:501-450-6350
Mailing Address - Fax:
Practice Address - Street 1:400 SALEM RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6162
Practice Address - Country:US
Practice Address - Phone:501-450-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09-19E101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor