1174663892 NPI number — MISS NELLIE RENA PARKER BEHAVIOR SHAPING SPE

Table of content: MISS NELLIE RENA PARKER BEHAVIOR SHAPING SPE (NPI 1174663892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174663892 NPI number — MISS NELLIE RENA PARKER BEHAVIOR SHAPING SPE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
NELLIE
Provider Middle Name:
RENA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BEHAVIOR SHAPING SPE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174663892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2811 SABINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71303-4321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-445-1874
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
242 W. SHAMROCK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-484-6850
Provider Business Practice Location Address Fax Number:
318-484-6232
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  7520 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 174400000X , with the licence number: 7520 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7520 . This is a "BEHAVIOR SHAPING SPECIALI" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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