Individual
MR. RANDALL M. PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, CADC
Contact information
Practice address
685 1ST ST, IDAHO FALLS, ID 83401-4003
(208) 932-4493
Mailing address
685 1ST ST, IDAHO FALLS, ID 83401-4003
(208) 681-2208
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCSW-44631
ID
101YA0400X
Addiction (Substance Use Disorder) Counselor
CADC-11672
ID
1041C0700X
Clinical Social Worker
LCSW-44631
ID
Other
Enumeration date
05/01/2016
Last updated
05/20/2025
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