Doctor Name: | SUE ELLEN PARKER |
NPI Number: | 1326399015 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180006558 |
Business Practice Address: | 12503 S 79th Ave Palos Park, IL - 604641929 |
Business Phone Number: | 7089237003 |
Business Fax Number: | |
Mailing Address: | 12503 S 79th Ave, PALOS PARK |
State: | IL |
Postal Code: | 604641929 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/21/2012 |
NPI Last Update Date: | 09/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180006558 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |