Provider Demographics
NPI:1417691809
Name:PARKER, CALLIE JEAN (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:JEAN
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4790 REDBANK EXPRESSWAY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227
Mailing Address - Country:US
Mailing Address - Phone:513-731-3346
Mailing Address - Fax:513-672-9539
Practice Address - Street 1:1 MEDICAL VILLAGE DR STE 117
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:513-731-3346
Practice Address - Fax:513-672-9539
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY269159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional