Provider Demographics
NPI:1346927654
Name:PETERSON PARKER, POLLY ANNA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:POLLY
Middle Name:ANNA
Last Name:PETERSON PARKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 FM 697
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-3734
Mailing Address - Country:US
Mailing Address - Phone:954-295-4923
Mailing Address - Fax:
Practice Address - Street 1:3761 FM 697
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-3734
Practice Address - Country:US
Practice Address - Phone:954-295-4923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67941041C0700X
VA09040037111041C0700X
TX1101321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical