MEDICARE: LAURA PARKS MMFT

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	101Y00000X	Counselor	1025	TN

General Provider Information

NPI Number	:	1639512916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA PARKS MMFT

Provider Business Mailing Address
First Line	:	2924 BERRY HILL DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3119
Country	:	US
Telephone Number	:	615-519-9336
Fax Number	:

Provider Business Practice Location Address
First Line	:	2924 BERRY HILL DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3119
Country	:	US
Telephone Number	:	615-519-9336
Fax Number	:

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

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	04/17/2013

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