Provider Demographics
NPI:1437277498
Name:PARKER, MARY NETTALYCE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NETTALYCE
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 1:223 N MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-1911
Mailing Address - Country:US
Mailing Address - Phone:310-669-9010
Mailing Address - Fax:
Practice Address - Street 1:5601 W SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6582
Practice Address - Country:US
Practice Address - Phone:310-641-7795
Practice Address - Fax:310-649-4347
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist