Provider Demographics
NPI:1417070186
Name:PARKER, AMY DAWN (MA, PLMHP)
Entity Type:Individual
Prefix:
First Name:AMY DAWN
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 N 31ST AVE STE C218
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9620
Mailing Address - Country:US
Mailing Address - Phone:602-815-6149
Mailing Address - Fax:
Practice Address - Street 1:10000 N 31ST AVE STE C218
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9620
Practice Address - Country:US
Practice Address - Phone:602-815-6149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7970101YM0800X
AZ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health