Provider Demographics
NPI:1306205190
Name:PARKER, CONSUELO (LPCC, LICDC)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19311 MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-2201
Mailing Address - Country:US
Mailing Address - Phone:216-240-4116
Mailing Address - Fax:
Practice Address - Street 1:19311 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2201
Practice Address - Country:US
Practice Address - Phone:216-240-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162067101YA0400X
OHC.1300627101YM0800X, 101YP2500X
OHE.2102196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional