Healthcare Provider Details

I. General information

NPI: 1699393439
Provider Name (Legal Business Name): KASONDRA PARR LPC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 E VALLEY AUTO DR STE 122
MESA AZ
85206-4632
US

IV. Provider business mailing address

2719 N 66TH ST
SCOTTSDALE AZ
85257-1154
US

V. Phone/Fax

Practice location:
  • Phone: 602-285-9696
  • Fax:
Mailing address:
  • Phone: 520-275-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-18805
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number14-207
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: