MEDICARE: MRS. JACQUELINE S PARKER LMSW

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	1041C0700X	Clinical Social Worker	22663	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	464056	OTHER		VALUE OPTIONS
3	109828513	OTHER	TX	UBH

General Provider Information

NPI Number	:	1386850014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE S PARKER LMSW

Provider Business Mailing Address
First Line	:	4808 MILL CREEK TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-5018
Country	:	US
Telephone Number	:	817-487-6775
Fax Number	:	817-236-3827

Provider Business Practice Location Address
First Line	:	4524 BOAT CLUB RD
Second Line	:	SUITE 188
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7025
Country	:	US
Telephone Number	:	817-487-6775
Fax Number	:	817-236-3827

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	04/27/2010

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