=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629354162
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY DAVIS PARKS M.S., LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2011
-----------------------------------------------------
Last Update Date | 10/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1820 3RD AVE N STE. 106
-----------------------------------------------------
City | BESSEMER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35020-4903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-260-4559
-----------------------------------------------------
Fax | 205-637-3699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 238
-----------------------------------------------------
City | PLEASANT GROVE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35127-0238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-260-4559
-----------------------------------------------------
Fax | 205-637-3699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number | 2950
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------