Provider Demographics
NPI:1780140376
Name:PARKER, TAKIIAH (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:TAKIIAH
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:TAKIIAH
Other - Middle Name:
Other - Last Name:HOLMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6685 QUINCE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8037
Mailing Address - Country:US
Mailing Address - Phone:901-567-5361
Mailing Address - Fax:
Practice Address - Street 1:711 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-5003
Practice Address - Country:US
Practice Address - Phone:901-584-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
TNLBA0000000593103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician