Healthcare Provider Details

I. General information

NPI: 1306677729
Provider Name (Legal Business Name): PRISCILLA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 17TH ST UNIT 2876
DENVER CO
80202-1508
US

IV. Provider business mailing address

1312 17TH ST UNIT 2876
DENVER CO
80202-1508
US

V. Phone/Fax

Practice location:
  • Phone: 727-563-4161
  • Fax:
Mailing address:
  • Phone: 727-563-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0024145
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: