Provider Demographics
NPI:1568427300
Name:PARKS, ASHLEY L (PSYD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:PARKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:L
Other - Last Name:DILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-3028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 COMMUNITY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-8804
Practice Address - Country:US
Practice Address - Phone:660-885-8131
Practice Address - Fax:660-885-2393
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034108103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499003143Medicaid