Provider Demographics
NPI:1629168794
Name:PARKER, CONSTANCE A
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:A
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:162 GROVE ST STE J
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2652
Mailing Address - Country:US
Mailing Address - Phone:760-873-6533
Mailing Address - Fax:760-873-3277
Practice Address - Street 1:162 GROVE ST STE J
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2652
Practice Address - Country:US
Practice Address - Phone:760-873-6533
Practice Address - Fax:760-873-3277
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health