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General NPI Number Information
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NPI Number | 1023708591
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Entity Type | Individual
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Provider Name | ANDREW ERIC PARKS LPC-MHSP
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Gender | Male
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 3069 S. BROAD ST. SUITE #9
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City | CHATTANOOGA
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State | TN
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Zip | 37408
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Country | US
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Telephone | 423-567-8769
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Fax |
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Provider Business Mailing Address
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Address Line | 3879 AZALEAN DR
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City | CHATTANOOGA
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State | TN
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Zip | 37415-3705
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Country | US
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Telephone | 502-380-6284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6025
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License Number State | TN
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