Healthcare Provider Details

I. General information

NPI: 1063592855
Provider Name (Legal Business Name): DANA JOLENE PARKER LCSW, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA JOLENE FULLER LCSW, LMFT

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S JOHN F KENNEDY AVE
LOOGOOTEE IN
47553-1624
US

IV. Provider business mailing address

202 E ELM ST
NEW ALBANY IN
47150-3429
US

V. Phone/Fax

Practice location:
  • Phone: 812-295-3090
  • Fax:
Mailing address:
  • Phone: 812-941-0922
  • Fax: 812-941-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000284A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003185A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: