Healthcare Provider Details

I. General information

NPI: 1164312682
Provider Name (Legal Business Name): JENNIFER M PARKS MED, MACP, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 EVANSTON AVE N STE 428
SEATTLE WA
98103-8970
US

IV. Provider business mailing address

3417 EVANSTON AVE N STE 428
SEATTLE WA
98103-8970
US

V. Phone/Fax

Practice location:
  • Phone: 206-720-1446
  • Fax:
Mailing address:
  • Phone: 206-720-1446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.617960
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: