Healthcare Provider Details

I. General information

NPI: 1942460589
Provider Name (Legal Business Name): MELISSA ROSE PARKER LMLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ROSE BARB LMLP

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 CAMPUS VIEW ST
GARDEN CITY KS
67846
US

IV. Provider business mailing address

PO BOX 477
GARDEN CITY KS
67846-0477
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-0644
  • Fax: 620-272-0239
Mailing address:
  • Phone: 620-275-0644
  • Fax: 620-272-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1330
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberTLMLP 1185
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: