Provider Demographics
NPI:1770968661
Name:PARKER, TRICIA (MA, PLPC)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 BOWLING LN
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:MO
Mailing Address - Zip Code:63650-4148
Mailing Address - Country:US
Mailing Address - Phone:573-546-7592
Mailing Address - Fax:
Practice Address - Street 1:541 COUNTY ROAD 112
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MO
Practice Address - Zip Code:63650-4149
Practice Address - Country:US
Practice Address - Phone:573-546-7592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020858101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional