MEDICARE: TY NESHA PARKS

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	171400000X	Health & Wellness Coach
2	251S00000X	Community/Behavioral Health Agency
3	172V00000X	Community Health Worker
4	251S00000X	Community/Behavioral Health Agency		TX
5	171M00000X	Case Manager/Care Coordinator	17925	TX
6	251B00000X	Case Management Agency
7	101YM0800X	Mental Health Counselor
8	174H00000X	Health Educator		TX

General Provider Information

NPI Number	:	1205516804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TY NESHA PARKS

Provider Business Mailing Address
First Line	:	2601 LITTLE ELM PKWY STE 1803
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-2503
Country	:	US
Telephone Number	:	866-448-3441
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 LITTLE ELM PKWY STE 1803
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-2503
Country	:	US
Telephone Number	:	469-957-6792
Fax Number	:

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

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	03/31/2026

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Directions to “ TY NESHA PARKS ” Practice Location

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