Provider Demographics
NPI:1073932596
Name:PARKER, JOHN (MS,LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:MS,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22710 N 123RD DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4563
Mailing Address - Country:US
Mailing Address - Phone:602-824-8312
Mailing Address - Fax:
Practice Address - Street 1:1245 JACK BURDEN RD
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-3370
Practice Address - Country:US
Practice Address - Phone:928-684-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-11
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012041377106H00000X
AZLMFT-15274106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist