Provider Demographics
NPI:1952614828
Name:PARKS, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9433 W GRANTOSA DR
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1501
Mailing Address - Country:US
Mailing Address - Phone:414-943-9559
Mailing Address - Fax:
Practice Address - Street 1:4200 N HOLTON ST
Practice Address - Street 2:SUITE 400
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1064
Practice Address - Country:US
Practice Address - Phone:414-964-2565
Practice Address - Fax:414-964-0102
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4395-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional