Provider Demographics
NPI:1639843188
Name:PARKER, NICHOLE (MS, RMFTI)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 FLORIDA 580
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761
Mailing Address - Country:US
Mailing Address - Phone:727-480-6669
Mailing Address - Fax:
Practice Address - Street 1:2759 FLORIDA 580
Practice Address - Street 2:SUITE 112
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761
Practice Address - Country:US
Practice Address - Phone:727-480-6669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist