Healthcare Provider Details

I. General information

NPI: 1841654084
Provider Name (Legal Business Name): MYRA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 ST CHARLES ST RM 101&102
LECOMPTE LA
71346
US

IV. Provider business mailing address

PO BOX 111
LECOMPTE LA
71346-0111
US

V. Phone/Fax

Practice location:
  • Phone: 504-416-5198
  • Fax:
Mailing address:
  • Phone: 504-416-5198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: