Healthcare Provider Details

I. General information

NPI: 1295816858
Provider Name (Legal Business Name): MARILYN PARKER M.A., LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 BROADWAY ST APT 24107
PEARLAND TX
77584-7424
US

IV. Provider business mailing address

PO BOX 84292
PEARLAND TX
77584-0016
US

V. Phone/Fax

Practice location:
  • Phone: 832-598-6561
  • Fax:
Mailing address:
  • Phone: 832-661-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number59988
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: