Provider Demographics
NPI:1275855181
Name:PARKER-RODRIGUEZ, LAKETHA MARIE (THERAPIST)
Entity Type:Individual
Prefix:
First Name:LAKETHA
Middle Name:MARIE
Last Name:PARKER-RODRIGUEZ
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:LAKETHA
Other - Middle Name:MARIE
Other - Last Name:PARKER-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THERAPIST
Mailing Address - Street 1:400 EDMONDS RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-3803
Mailing Address - Country:US
Mailing Address - Phone:650-839-1810
Mailing Address - Fax:
Practice Address - Street 1:400 EDMONDS RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-3803
Practice Address - Country:US
Practice Address - Phone:650-839-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA106182106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health