Doctor Name: | MARY M PARKS |
NPI Number: | 1093174047 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCDC |
License Number: | 11538 |
Business Practice Address: | 109 W Mall Dr Corsicana, TX - 751103102 |
Business Phone Number: | 9038726727 |
Business Fax Number: | |
Mailing Address: | 109 W Mall Dr, CORSICANA |
State: | TX |
Postal Code: | 751103102 |
Phone Number: | 9038726727 |
Fax Number: | |
NPI Enumeration Date: | 02/18/2016 |
NPI Last Update Date: | 02/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 11538 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |