Provider Demographics
NPI:1235385444
Name:PARKER, MARY JEANETTE
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEANETTE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JEANETTE
Other - Last Name:BAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2100 E BROADWAY
Mailing Address - Street 2:SUITE 315
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6082
Mailing Address - Country:US
Mailing Address - Phone:573-442-8550
Mailing Address - Fax:
Practice Address - Street 1:6111 E CLAYSVILLE RD
Practice Address - Street 2:
Practice Address - City:HARTSBURG
Practice Address - State:MO
Practice Address - Zip Code:65039-9625
Practice Address - Country:US
Practice Address - Phone:573-761-0696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional