Provider Demographics
NPI:1821173030
Name:PARKER DENNIS, BEVERLY SUSAN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:SUSAN
Last Name:PARKER DENNIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:BEVERLY
Other - Middle Name:SUSAN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M
Mailing Address - Street 1:2160 FLETCHER PKWY
Mailing Address - Street 2:B-1
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-2139
Mailing Address - Country:US
Mailing Address - Phone:619-562-9000
Mailing Address - Fax:619-670-5010
Practice Address - Street 1:2160 FLETCHER PARKWAY
Practice Address - Street 2:B-1
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2115
Practice Address - Country:US
Practice Address - Phone:619-562-9000
Practice Address - Fax:619-670-5010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT39404106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MFT39404OtherLICENSE