Provider Demographics
NPI:1710483870
Name:PARKER, SHAWNTEE DENISE
Entity Type:Individual
Prefix:MS
First Name:SHAWNTEE
Middle Name:DENISE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5836 DUDLEY BLVD APT 230
Mailing Address - Street 2:
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-2436
Mailing Address - Country:US
Mailing Address - Phone:916-890-7074
Mailing Address - Fax:
Practice Address - Street 1:9738 LINCOLN VILLAGE DR STE 120
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3380
Practice Address - Country:US
Practice Address - Phone:916-714-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)