Provider Demographics
NPI:1457794554
Name:PARKER, ALICIA CAMILLE
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:CAMILLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:CAMILLE
Other - Last Name:HERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 1-4
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5362
Mailing Address - Country:US
Mailing Address - Phone:702-778-8922
Mailing Address - Fax:
Practice Address - Street 1:101 S RAINBOW BLVD
Practice Address - Street 2:SUITE 1-4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5362
Practice Address - Country:US
Practice Address - Phone:702-778-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner