Provider Demographics
NPI:1093567703
Name:PARKER, LEAH SUZANNE (MED, CSC, LPC-A)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:SUZANNE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MED, CSC, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 SALT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802-2310
Mailing Address - Country:US
Mailing Address - Phone:817-727-7000
Mailing Address - Fax:
Practice Address - Street 1:404 SALT CREEK DR
Practice Address - Street 2:
Practice Address - City:EARLY
Practice Address - State:TX
Practice Address - Zip Code:76802-2310
Practice Address - Country:US
Practice Address - Phone:817-727-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional