MEDICARE: DR. BRIAN PARKS PH.D.

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	103TC1900X	Counseling Psychologist	2188	OR

General Provider Information

NPI Number	:	1043619067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN PARKS PH.D.

Provider Business Mailing Address
First Line	:	3575 DONALD ST STE 650
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-4784
Country	:	US
Telephone Number	:	458-213-4761
Fax Number	:	541-919-0055

Provider Business Practice Location Address
First Line	:	3575 DONALD ST STE 650
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-4784
Country	:	US
Telephone Number	:	458-213-4761
Fax Number	:	541-919-0055

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

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	05/27/2021

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Directions to “ DR. BRIAN PARKS PH.D.” Practice Location

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