Healthcare Provider Details

I. General information

NPI: 1083183404
Provider Name (Legal Business Name): MEA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BAKER ST STE A
COSTA MESA CA
92626-4566
US

IV. Provider business mailing address

275 BAKER ST STE A
COSTA MESA CA
92626-4566
US

V. Phone/Fax

Practice location:
  • Phone: 714-226-9888
  • Fax:
Mailing address:
  • Phone: 714-226-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14294622-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018955
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: