Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1003128521 |
---|---|
Provider Name | Tina Nicole Parker |
First Address | Clarksville, TN 37040-5115 |
Second Address | Clarksville, TN 37040-5115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 13/07/2010 |