Provider Demographics
NPI:1043619067
Name:PARKS, BRIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:PARKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 DONALD ST STE 650
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4784
Mailing Address - Country:US
Mailing Address - Phone:458-213-4761
Mailing Address - Fax:541-919-0055
Practice Address - Street 1:3575 DONALD ST STE 650
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4784
Practice Address - Country:US
Practice Address - Phone:458-213-4761
Practice Address - Fax:541-919-0055
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2188103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling