Provider Demographics
NPI:1598197386
Name:PARKS, GEORGE ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ANDREW
Last Name:PARKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 150TH PL SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4338
Mailing Address - Country:US
Mailing Address - Phone:206-930-1949
Mailing Address - Fax:
Practice Address - Street 1:5222 150TH PL SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-4338
Practice Address - Country:US
Practice Address - Phone:206-930-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002277103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist