Provider Demographics
NPI:1508099086
Name:PARKS GEHRUNG, ANITA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:PARKS GEHRUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2732 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-3750
Mailing Address - Country:US
Mailing Address - Phone:317-554-4600
Mailing Address - Fax:317-554-4669
Practice Address - Street 1:2732 W MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-3750
Practice Address - Country:US
Practice Address - Phone:317-554-4600
Practice Address - Fax:317-554-4669
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005739A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical