MEDICARE: SHANNON PARKER

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	277167	KY

General Provider Information

NPI Number	:	1740842301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON PARKER

Provider Business Mailing Address
First Line	:	PO BOX 870
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-0870
Country	:	US
Telephone Number	:	859-705-8075
Fax Number	:	502-795-3584

Provider Business Practice Location Address
First Line	:	620 EUCLID AVE STE 203
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-6429
Country	:	US
Telephone Number	:	859-705-8075
Fax Number	:

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

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	05/18/2022

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Directions to “ SHANNON PARKER ” Practice Location

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