Provider Demographics
NPI:1235338435
Name:PARNELL, BEVERLY SUE (CAC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:SUE
Last Name:PARNELL
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:SUE
Other - Last Name:TICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAC
Mailing Address - Street 1:6005 FINANCIAL PLZ
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-2615
Mailing Address - Country:US
Mailing Address - Phone:318-632-2040
Mailing Address - Fax:318-632-2073
Practice Address - Street 1:1310 N HEARNE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6516
Practice Address - Country:US
Practice Address - Phone:318-676-5111
Practice Address - Fax:318-676-5944
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1024101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)