Provider Demographics
NPI:1205966405
Name:PARKS, LOUISA A (PSYD)
Entity type:Individual
Prefix:DR
First Name:LOUISA
Middle Name:A
Last Name:PARKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 CREED RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1826
Mailing Address - Country:US
Mailing Address - Phone:855-377-2757
Mailing Address - Fax:510-625-0662
Practice Address - Street 1:4000 BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5670
Practice Address - Country:US
Practice Address - Phone:855-377-2757
Practice Address - Fax:510-625-0662
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24459103G00000X, 103TC0700X
NY019162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist