Provider Demographics
NPI:1558558775
Name:PARKER, KATHRYN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name: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 1:4615 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3826
Mailing Address - Country:US
Mailing Address - Phone:423-205-1258
Mailing Address - Fax:
Practice Address - Street 1:4615 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3826
Practice Address - Country:US
Practice Address - Phone:423-205-1258
Practice Address - Fax:423-497-5315
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN54991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health