Provider Demographics
NPI:1184193062
Name:PARKER, MARY PAT (MHP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PAT
Last Name:PARKER
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7623
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71137-7623
Mailing Address - Country:US
Mailing Address - Phone:318-771-2190
Mailing Address - Fax:
Practice Address - Street 1:4335 OLD MOORINGSPORT RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-2937
Practice Address - Country:US
Practice Address - Phone:318-771-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health