Provider Demographics
NPI:1164471538
Name:OTTO-PARKINSON, NECOE LYNNN (PHD)
Entity Type:Individual
Prefix:
First Name:NECOE
Middle Name:LYNNN
Last Name:OTTO-PARKINSON
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 1:2200 E RIVER RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6579
Mailing Address - Country:US
Mailing Address - Phone:520-971-5578
Mailing Address - Fax:520-297-7002
Practice Address - Street 1:6837 N ORACLE RD
Practice Address - Street 2:UNIT 14
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4292
Practice Address - Country:US
Practice Address - Phone:520-971-5578
Practice Address - Fax:520-297-7002
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ110337Medicare PIN