Healthcare Provider Details

I. General information

NPI: 1124837992
Provider Name (Legal Business Name): MRS. HEATHER D PARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N MAIN ST
CLEBURNE TX
76033-3816
US

IV. Provider business mailing address

805 N MAIN ST
CLEBURNE TX
76033-3816
US

V. Phone/Fax

Practice location:
  • Phone: 817-202-3976
  • Fax: 817-202-3978
Mailing address:
  • Phone: 817-202-3976
  • Fax: 817-202-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number93044
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: