Provider Demographics
NPI:1235203738
Name:PARKS, SHAD CHRISTIAN (CATC SMHC)
Entity Type:Individual
Prefix:
First Name:SHAD
Middle Name:CHRISTIAN
Last Name:PARKS
Suffix:
Gender:M
Credentials:CATC SMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 COUNTY CENTER DR STE C
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-3317
Mailing Address - Country:US
Mailing Address - Phone:530-538-2170
Mailing Address - Fax:
Practice Address - Street 1:18 COUNTY CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3317
Practice Address - Country:US
Practice Address - Phone:530-538-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020595OtherCAADE