Doctor Name: | CARMEN ANN PARKS |
NPI Number: | 1992059984 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADC |
License Number: | 303403 |
Business Practice Address: | 840 E Main St Perham, MN - 565731934 |
Business Phone Number: | 2183466100 |
Business Fax Number: | 2183466112 |
Mailing Address: | 840 E Main St, PERHAM |
State: | MN |
Postal Code: | 565731934 |
Phone Number: | 2183466100 |
Fax Number: | 2183466112 |
NPI Enumeration Date: | 10/30/2012 |
NPI Last Update Date: | 10/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 303403 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |