Healthcare Provider Details

I. General information

NPI: 1194643726
Provider Name (Legal Business Name): JESSICA ALIZ PARKS SR.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 24TH AVE S STE 200
SEATTLE WA
98144-4643
US

IV. Provider business mailing address

140 23RD AVE S APT 303
SEATTLE WA
98144-4364
US

V. Phone/Fax

Practice location:
  • Phone: 206-767-7000
  • Fax:
Mailing address:
  • Phone: 206-271-1867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: