MEDICARE: TIMOTHY GLENN PARKER LMFT

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	106H00000X	Marriage & Family Therapist	0001399	CO
2	106H00000X	Marriage & Family Therapist	201311	TX

General Provider Information

NPI Number	:	1245474543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY GLENN PARKER LMFT

Provider Business Mailing Address
First Line	:	PO BOX 170645
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78717-0032
Country	:	US
Telephone Number	:	512-222-9509
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 COTTONWOOD CREEK TRL STE 300
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2688
Country	:	US
Telephone Number	:	512-222-9509
Fax Number	:

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

Provider Enumeration Date	:	04/30/2009
Last Update Date	:	01/16/2024

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