Provider Demographics
NPI:1659119048
Name:PARKER, TELISA SHARESSE
Entity type:Individual
Prefix:MS
First Name:TELISA
Middle Name:SHARESSE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25596 WEDMORE DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4718
Mailing Address - Country:US
Mailing Address - Phone:562-326-4622
Mailing Address - Fax:
Practice Address - Street 1:28721 LIVE OAK CANYON RD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7913
Practice Address - Country:US
Practice Address - Phone:562-832-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142188106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist