Provider Demographics
NPI:1831996743
Name:PARKS, ASHLYN (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:
Last Name:PARKS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 OLD PECOS TRL STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4779
Mailing Address - Country:US
Mailing Address - Phone:512-214-7602
Mailing Address - Fax:
Practice Address - Street 1:1660 OLD PECOS TRL STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4779
Practice Address - Country:US
Practice Address - Phone:512-214-7602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2025-01541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1023713682OtherSOUTHWEST HEALTHWORKS