Provider Demographics
NPI:1578968525
Name:PARKER, MELODI (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MELODI
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 N HAMPTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8621
Mailing Address - Country:US
Mailing Address - Phone:469-518-6034
Mailing Address - Fax:
Practice Address - Street 1:1636 N HAMPTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8621
Practice Address - Country:US
Practice Address - Phone:469-518-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70014101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health