Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY-004988 | AZ |
Y | 103T00000X | Psychologist | PSY-004988 | AZ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY-004988 | AZ |
N | 103TS0200X | School Psychologist | PSY-004988 | AZ |
NPI | 1104496686 |
---|---|
Provider Name | Dr. Alice Parker |
First Address | Peoria, AZ 85381-8526 |
Second Address | Peoria, AZ 85381-8526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2021 |
Last Update Date | 28/06/2021 |