MEDICARE: ISABELLE PARKER MFT

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	101YM0800X	Mental Health Counselor	1216	NV

General Provider Information

NPI Number	:	1194293902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABELLE PARKER MFT

Provider Business Mailing Address
First Line	:	4470 N GRAND CANYON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-2686
Country	:	US
Telephone Number	:	702-768-6896
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 CLIFF SHADOWS PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5111
Country	:	US
Telephone Number	:	702-673-4745
Fax Number	:

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

Provider Enumeration Date	:	11/09/2018
Last Update Date	:	09/26/2020

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