Provider Demographics
NPI:1629354162
Name:PARKS, TAMMY DAVIS (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:DAVIS
Last Name:PARKS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35127-0238
Mailing Address - Country:US
Mailing Address - Phone:205-260-4559
Mailing Address - Fax:205-637-3699
Practice Address - Street 1:1820 3RD AVE N
Practice Address - Street 2:STE. 106
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-4903
Practice Address - Country:US
Practice Address - Phone:205-260-4559
Practice Address - Fax:205-637-3699
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2950305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization