Provider Demographics
NPI:1770921355
Name:PARKER, BRENDA (MS, CDPT, MHCA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, CDPT, MHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 N DALLAS RD APT I204
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-9145
Mailing Address - Country:US
Mailing Address - Phone:402-720-6804
Mailing Address - Fax:
Practice Address - Street 1:1305 MANSFIELD ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3588
Practice Address - Country:US
Practice Address - Phone:509-942-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60548687101YM0800X
WACO60556779101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health