MEDICARE: LAURIE JEAN PARKER LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	144-S	NV

General Provider Information

NPI Number	:	1225505043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE JEAN PARKER LADC

Provider Business Mailing Address
First Line	:	1161 S LOOP RD
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-4764
Country	:	US
Telephone Number	:	775-751-6990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1161 S LOOP RD
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-4764
Country	:	US
Telephone Number	:	775-751-6990
Fax Number	:

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

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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