Healthcare Provider Details

I. General information

NPI: 1417897190
Provider Name (Legal Business Name): MARY PARKS BA, CAP, NCPRSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N CONGRESS AVE
BOYNTON BEACH FL
33426-3303
US

IV. Provider business mailing address

8958 GREY EAGLE DR
BOYNTON BEACH FL
33472-1245
US

V. Phone/Fax

Practice location:
  • Phone: 561-223-6484
  • Fax: 561-327-6484
Mailing address:
  • Phone: 561-596-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: