Healthcare Provider Details

I. General information

NPI: 1306778303
Provider Name (Legal Business Name): PARKER RISING-EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 N LAKES PL
MERIDIAN ID
83646-1833
US

IV. Provider business mailing address

304 W BUCK CT
KUNA ID
83634-3321
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-5905
  • Fax:
Mailing address:
  • Phone: 208-440-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8481610
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: