Provider Demographics
NPI:1689730392
Name:PARKER, MARY ELLA (MS NCC CCMHC LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLA
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS NCC CCMHC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870
Mailing Address - Country:US
Mailing Address - Phone:417-781-2389
Mailing Address - Fax:
Practice Address - Street 1:1906 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870
Practice Address - Country:US
Practice Address - Phone:417-781-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS001987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health