Healthcare Provider Details

I. General information

NPI: 1073440830
Provider Name (Legal Business Name): JAN PARKER, MFA, MA, LCPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 N RAVENSWOOD AVE STE 306B
CHICAGO IL
60613-5683
US

IV. Provider business mailing address

4725 N LINCOLN AVE APT 2C
CHICAGO IL
60625-2062
US

V. Phone/Fax

Practice location:
  • Phone: 479-462-9133
  • Fax:
Mailing address:
  • Phone: 479-462-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. JANIS LYNN PARKER
Title or Position: MENTAL HEALTH THERAPIST
Credential: MA, LCPC
Phone: 479-462-9133