Healthcare Provider Details

I. General information

NPI: 1407386964
Provider Name (Legal Business Name): ERIKA PARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 07/21/2022
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 11TH ST
WEST PALM BEACH FL
33401-3137
US

IV. Provider business mailing address

1311 11TH ST
WEST PALM BEACH FL
33401-3137
US

V. Phone/Fax

Practice location:
  • Phone: 407-955-6202
  • Fax:
Mailing address:
  • Phone: 407-955-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: