Provider Demographics
NPI:1346003977
Name:PARKER, TIG ELLIOTT
Entity Type:Individual
Prefix:
First Name:TIG
Middle Name:ELLIOTT
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 JEAN ST APT 8
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1493
Mailing Address - Country:US
Mailing Address - Phone:415-846-4599
Mailing Address - Fax:
Practice Address - Street 1:733 JEAN ST APT 8
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1493
Practice Address - Country:US
Practice Address - Phone:415-846-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist