Provider Demographics
NPI:1003885195
Name:PARKER, SUSAN KATHERINE (LPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KATHERINE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CALIFORNIA TRL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4314
Mailing Address - Country:US
Mailing Address - Phone:972-517-8138
Mailing Address - Fax:
Practice Address - Street 1:2121 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE 114
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4100
Practice Address - Country:US
Practice Address - Phone:972-517-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09965101YP2500X
TX01383106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115428000OtherMAGELLAN
TX125820Medicaid
TX00002775LCOtherBLUE CROSS& BLUE SHIELD
TX4309701OtherAETNA
TX125820OtherVALUE OPTIONS
TXLP0012305Medicaid