Healthcare Provider Details

I. General information

NPI: 1790449262
Provider Name (Legal Business Name): ANNIE PARKER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22001 FAIRMOUNT BLVD.
CLEVELAND OH
44118
US

IV. Provider business mailing address

22001 FAIRMOUNT BLVD
CLEVELAND OH
44118-4819
US

V. Phone/Fax

Practice location:
  • Phone: 216-932-2800
  • Fax:
Mailing address:
  • Phone: 216-932-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2607130
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: