Healthcare Provider Details

I. General information

NPI: 1295399541
Provider Name (Legal Business Name): NICHOLAS PARKS M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 VALLEYDALE RD STE 107
HOOVER AL
35244-2719
US

IV. Provider business mailing address

1097 HIGHLAND VILLAGE TRL
BIRMINGHAM AL
35242-6651
US

V. Phone/Fax

Practice location:
  • Phone: 205-600-0134
  • Fax:
Mailing address:
  • Phone: 205-914-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: