Provider Demographics
NPI:1033124441
Name:PARRISH, THERESA KAY (LCPC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:KAY
Last Name:PARRISH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N WYMAN ST
Mailing Address - Street 2:SUITE M1
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-1114
Mailing Address - Country:US
Mailing Address - Phone:815-986-1130
Mailing Address - Fax:815-986-1135
Practice Address - Street 1:127 N WYMAN ST
Practice Address - Street 2:SUITE M1
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-1114
Practice Address - Country:US
Practice Address - Phone:815-986-1130
Practice Address - Fax:815-986-1135
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional