Provider Demographics
NPI:1174663892
Name:PARKER, NELLIE RENA (BEHAVIOR SHAPING SPE)
Entity Type:Individual
Prefix:MISS
First Name:NELLIE
Middle Name:RENA
Last Name:PARKER
Suffix:
Gender:F
Credentials:BEHAVIOR SHAPING SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 SABINE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-4321
Mailing Address - Country:US
Mailing Address - Phone:318-445-1874
Mailing Address - Fax:
Practice Address - Street 1:242 W. SHAMROCK STREET
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6850
Practice Address - Fax:318-484-6232
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7520101YM0800X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7520OtherBEHAVIOR SHAPING SPECIALI