Provider Demographics
NPI:1790438760
Name:PARKER, BRENDA R (LAC)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:R
Last Name:PARKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S 7TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2509
Mailing Address - Country:US
Mailing Address - Phone:520-266-1819
Mailing Address - Fax:
Practice Address - Street 1:100 S 7TH ST STE 5
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2509
Practice Address - Country:US
Practice Address - Phone:520-266-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health