1215271135 NPI number — JESSICA KATHLEEN PARKER PHD, LMHC, LCPC

Table of content: JESSICA KATHLEEN PARKER PHD, LMHC, LCPC (NPI 1215271135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215271135 NPI number — JESSICA KATHLEEN PARKER PHD, LMHC, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
JESSICA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, LMHC, LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKER
Provider Other First Name:
JESSICA
Provider Other Middle Name:
RUST
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215271135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 E PIONEER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98372-3265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-697-8400
Provider Business Mailing Address Fax Number:
253-697-3730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 8TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALGONA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98001-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-512-4769
Provider Business Practice Location Address Fax Number:
253-268-1121
Provider Enumeration Date:
11/15/2012

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LH60588445 . This is a "LICENSED MENTAL HEALTH COUNSELOR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: LCPC-8023 . This is a "LICENSED CLINICAL PROFESSIONAL COUNSELOR" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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