MEDICARE: PAMELA PARKER QMHP TO

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1821472150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA PARKER QMHP TO

Provider Business Mailing Address
First Line	:	602 SOUTH ST STE D-1
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-1499
Country	:	US
Telephone Number	:	440-285-3537
Fax Number	:	440-285-4909

Provider Business Practice Location Address
First Line	:	602 SOUTH ST STE D-1
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-1499
Country	:	US
Telephone Number	:	440-285-3537
Fax Number	:	440-285-4909

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

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2015

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