Provider Demographics
NPI:1295399541
Name:PARKS, NICHOLAS (MS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PARKS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 HIGHLAND VILLAGE TRL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6651
Mailing Address - Country:US
Mailing Address - Phone:205-914-2556
Mailing Address - Fax:
Practice Address - Street 1:2200 VALLEYDALE RD STE 107
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2719
Practice Address - Country:US
Practice Address - Phone:205-600-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1083133003Medicaid