Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 09965 | TX |
NPI | 1003885195 |
---|---|
Provider Name | Ms. Susan Katherine Parker |
First Address | Plano, TX 75023-4314 |
Second Address | Plano, TX 75023-4100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 10/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00002775LC | BLUE CROSS& BLUE SHIELD (01) | TX |
115428000 | MAGELLAN (01) | TX |
125820 | (05) | TX |
125820 | VALUE OPTIONS (01) | TX |
4309701 | AETNA (01) | TX |
LP0012305 | (05) | TX |