Provider Demographics
NPI:1942460589
Name:PARKER, MELISSA ROSE (LMLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ROSE
Other - Last Name:BARB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMLP
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-0477
Mailing Address - Country:US
Mailing Address - Phone:620-275-0644
Mailing Address - Fax:620-272-0239
Practice Address - Street 1:531 CAMPUS VIEW ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846
Practice Address - Country:US
Practice Address - Phone:620-275-0644
Practice Address - Fax:620-272-0239
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTLMLP 1185103TC0700X
KS1330103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200556370AMedicaid