Provider Demographics
NPI:1811797467
Name:PARKS, JOHN JAMES
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:PARKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-9753
Mailing Address - Country:US
Mailing Address - Phone:608-630-7558
Mailing Address - Fax:
Practice Address - Street 1:2270 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3337
Practice Address - Country:US
Practice Address - Phone:651-724-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor