Provider Demographics
NPI:1639457328
Name:PARKER, TASHA LYNN (LSCSW)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:LYNN
Last Name:PARKER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 PLAZA LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4154
Mailing Address - Country:US
Mailing Address - Phone:316-650-9285
Mailing Address - Fax:
Practice Address - Street 1:650 N CARRIAGE PKWY STE 135
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4514
Practice Address - Country:US
Practice Address - Phone:316-927-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8116104100000X
KS43111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker