Provider Demographics
NPI:1962686105
Name:PARKER, BRIAN LEONARD (MS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LEONARD
Last Name:PARKER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:LEONARD
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:1173 S 250 W
Mailing Address - Street 2:SUIET 202B
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6392
Mailing Address - Country:US
Mailing Address - Phone:435-635-6014
Mailing Address - Fax:
Practice Address - Street 1:1173 S 250 W
Practice Address - Street 2:SUIET 202B
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6392
Practice Address - Country:US
Practice Address - Phone:435-635-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4929978-3902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional