Healthcare Provider Details

I. General information

NPI: 1679193395
Provider Name (Legal Business Name): ALEXIS KIMANI PARKER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 COMMERCENTER E STE 232
SAN BERNARDINO CA
92408-3479
US

IV. Provider business mailing address

5310 CANYON CREST DR APT 51
RIVERSIDE CA
92507-6367
US

V. Phone/Fax

Practice location:
  • Phone: 951-316-3450
  • Fax:
Mailing address:
  • Phone: 951-316-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC6310
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: