Provider Demographics
NPI:1841464856
Name:PARKER, KATINA DAWN (LCAC)
Entity type:Individual
Prefix:MRS
First Name:KATINA
Middle Name:DAWN
Last Name:PARKER
Suffix:
Gender:
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 E ORME ST STE A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2424
Mailing Address - Country:US
Mailing Address - Phone:316-686-7884
Mailing Address - Fax:316-686-0036
Practice Address - Street 1:8911 E ORME ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2423
Practice Address - Country:US
Practice Address - Phone:163-395-9395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00862101YA0400X
KS1000101YP2500X
KS2756103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional