MEDICARE: TANYA M PARKER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.022954	IL
2	1041C0700X	Clinical Social Worker	2024016102	MO
3	1041C0700X	Clinical Social Worker	121560	CA

General Provider Information

NPI Number	:	1033701487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA M PARKER LCSW

Provider Business Mailing Address
First Line	:	4237 MCPHERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2907
Country	:	US
Telephone Number	:	314-619-2489
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 OLD MILL RD SPC 62
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93110-3724
Country	:	US
Telephone Number	:	314-619-2489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	01/22/2025

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