Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2188 | OR |
NPI | 1043619067 |
---|---|
Provider Name | Dr. Brian Parks |
First Address | Eugene, OR 97405-4784 |
Second Address | Eugene, OR 97405-4784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2014 |
Last Update Date | 27/05/2021 |