Healthcare Provider Details

I. General information

NPI: 1760029979
Provider Name (Legal Business Name): RALEISA PARKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 E GREENWAY RD STE 100
PHOENIX AZ
85032-4805
US

IV. Provider business mailing address

5054 BREEZEWAY DR
TOLEDO OH
43613-2523
US

V. Phone/Fax

Practice location:
  • Phone: 480-674-9220
  • Fax:
Mailing address:
  • Phone: 531-777-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-24977
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2607458
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: