Provider Demographics
NPI:1639512916
Name:PARKS, LAURA (MMFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 BERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3119
Mailing Address - Country:US
Mailing Address - Phone:615-519-9336
Mailing Address - Fax:
Practice Address - Street 1:2924 BERRY HILL DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3119
Practice Address - Country:US
Practice Address - Phone:615-519-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1025101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor