MEDICARE: MS. AMY L PARKE LCSW

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	21651	TX

General Provider Information

NPI Number	:	1427036037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY L PARKE LCSW

Provider Business Mailing Address
First Line	:	6047 COUNTY ROAD 223
Second Line	:
City	:	KEMPNER
State	:	TX
Zip	:	76539-3753
Country	:	US
Telephone Number	:	254-833-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	36000 DARNALL LOOP
Second Line	:	DEPT OF EMERGENCY MEDICINE
City	:	FORT HOOD
State	:	TX
Zip	:	76554-4752
Country	:	US
Telephone Number	:	254-288-8889
Fax Number	:

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	09/18/2008

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