Provider Demographics
NPI:1295816858
Name:PARKER, MARILYN (MA, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84292
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0016
Mailing Address - Country:US
Mailing Address - Phone:832-661-6325
Mailing Address - Fax:
Practice Address - Street 1:12501 BROADWAY ST APT 24107
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7424
Practice Address - Country:US
Practice Address - Phone:832-598-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YS0200X
TX59988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1295816858Medicaid
TX183881501Medicaid