Provider Demographics
NPI:1033591946
Name:PARKS, CHELEASE
Entity Type:Individual
Prefix:
First Name:CHELEASE
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E IOWA ST
Mailing Address - Street 2:2A
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1943
Mailing Address - Country:US
Mailing Address - Phone:563-570-0630
Mailing Address - Fax:
Practice Address - Street 1:800 E IOWA ST
Practice Address - Street 2:2A
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1943
Practice Address - Country:US
Practice Address - Phone:563-570-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral