Provider Demographics
NPI:1003852260
Name:PARKER, JACQUELINE (LCSW, ACSW, QCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSW, ACSW, QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 DOVE HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-1945
Mailing Address - Country:US
Mailing Address - Phone:817-461-4063
Mailing Address - Fax:817-461-0146
Practice Address - Street 1:4701 DOVE HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-1945
Practice Address - Country:US
Practice Address - Phone:817-461-4063
Practice Address - Fax:817-461-0146
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00767101YM0800X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S09GMedicare ID - Type Unspecified