Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | IL |
NPI | 1033591946 |
---|---|
Provider Name | Chelease Parks |
First Address | Eldridge, IA 52748-1943 |
Second Address | Eldridge, IA 52748-1943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2015 |
Last Update Date | 26/06/2015 |