Healthcare Provider Details

I. General information

NPI: 1093975286
Provider Name (Legal Business Name): REBECCA L. PARKER MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 MAJOR AVE
RIVERTON WY
82501-2342
US

IV. Provider business mailing address

1110 MAJOR AVE
RIVERTON WY
82501-2342
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-6587
  • Fax: 307-856-2668
Mailing address:
  • Phone: 307-856-6587
  • Fax: 307-856-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 769
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: