Provider Demographics
NPI:1053458356
Name:PARKER, RENE K (MA,LPC)
Entity Type:Individual
Prefix:MS
First Name:RENE
Middle Name:K
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9378 OLIVE BLVD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3215
Mailing Address - Country:US
Mailing Address - Phone:314-420-3580
Mailing Address - Fax:314-567-8581
Practice Address - Street 1:9378 OLIVE BLVD
Practice Address - Street 2:SUITE 314
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3215
Practice Address - Country:US
Practice Address - Phone:314-420-3580
Practice Address - Fax:314-567-8581
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004003792OtherLICENSE NO.