Provider Demographics
NPI:1043558307
Name:PARKER, CYNTHIA ELAINE (PHD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 NE HIGHWAY 99 STE G185
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8799
Mailing Address - Country:US
Mailing Address - Phone:360-904-9398
Mailing Address - Fax:360-368-8747
Practice Address - Street 1:612 E 17TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3428
Practice Address - Country:US
Practice Address - Phone:360-904-9398
Practice Address - Fax:360-368-8747
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60245063103TC0700X
WAPY6245063103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2027677Medicaid
WASWV0179425-02OtherLABOR AND INDUSTRY