Active NPI
Tresvil Gerard Pack, PH.D., CRC, LPC
- Professional Counselor
- Conway, AR
National Provider Identifier
1831494905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- P1101006
- Practice address
- 930 Wingate St Ste D2
Conway, AR 72034-4837 - Phone
- (501) 499-8699
- NPI assigned
- Jan 20, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | P1101006 | AR | Primary |
Addresses
Primary practice location
930 Wingate St Ste D2
Conway, AR 72034-4837
Mailing address
PO Box 11770
Conway, AR 72034-0031
Phone (501) 499-8699
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P1101006 | AR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehabilitation & Counseling Consultants | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Professional Counselor
- Conway, AR
- NPI 1194076737
Professional
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348358400000",
"number": "1831494905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11770",
"city": "CONWAY",
"state": "AR",
"postal_code": "720340031",
"telephone_number": "501-499-8699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 WINGATE ST STE D2",
"city": "CONWAY",
"state": "AR",
"postal_code": "720344837",
"telephone_number": "501-499-8699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACK",
"first_name": "TRESVIL",
"middle_name": "GERARD",
"name_prefix": "Dr.",
"credential": "PH.D., CRC, LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-01-20",
"last_updated": "2012-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AR",
"license": "P1101006",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.