Provider Demographics
NPI:1699393439
Name:PARR, KASONDRA (LPC, ATR)
Entity Type:Individual
Prefix:
First Name:KASONDRA
Middle Name:
Last Name:PARR
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 N 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1154
Mailing Address - Country:US
Mailing Address - Phone:520-275-8720
Mailing Address - Fax:
Practice Address - Street 1:4121 E VALLEY AUTO DR STE 122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4632
Practice Address - Country:US
Practice Address - Phone:602-285-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14-207221700000X
AZLPC-18805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist