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NPI Code Detail

MEDICARE: SHAYNA PARKER

MEDICARE: SHAYNA 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
1101YP2500XProfessional Counselor2017010560MO
21041C0700XClinical Social Worker2021025415MO

General Provider Information

NPI Number : 1912426586
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAYNA PARKER
Provider Business Mailing Address
First Line : 11701 W FLORISSANT AVE
Second Line :
City : FLORISSANT
State : MO
Zip : 63033-6744
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11701 W FLORISSANT AVE
Second Line :
City : FLORISSANT
State : MO
Zip : 63033-6744
Country : US
Telephone Number : 314-972-8132
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2017
Last Update Date : 01/27/2022

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Directions to “ SHAYNA PARKER ” Practice Location

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