MEDICARE: CAROL L. PARKER PH.D.LPCC

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	251S00000X	Community/Behavioral Health Agency	4775	NM

General Provider Information

NPI Number	:	1386037364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROL L. PARKER PH.D.LPCC

Provider Business Mailing Address
First Line	:	PO BOX 544
Second Line	:
City	:	GLORIETA
State	:	NM
Zip	:	87535-0544
Country	:	US
Telephone Number	:	505-235-1284
Fax Number	:	505-982-9401

Provider Business Practice Location Address
First Line	:	1600 LENA ST STE C
Second Line	:	#30
City	:	SANTA FE
State	:	NM
Zip	:	87505-3891
Country	:	US
Telephone Number	:	505-235-1284
Fax Number	:	505-982-9401

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. CAROL L. PARKER
Credential	:	PH.D. LPCC
Telephone Number	:	505-235-1284

Provider Enumeration Date	:	03/14/2015
Last Update Date	:	03/14/2015

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