=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285101311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TASHA L. PARKER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2018
-----------------------------------------------------
Last Update Date | 10/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5517 PLAZA LN
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67208-4154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-202-8672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5517 PLAZA LN
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67208-4154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-650-9285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | TASHA PARKER
-----------------------------------------------------
Credential | LSCSW
-----------------------------------------------------
Telephone | 316-650-9285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------