Basic Information
Provider Information
NPI: 1528539616
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARKER
FirstName: SHARLENE
MiddleName: Y
NamePrefix:  
NameSuffix:  
Credential: DOCTORATE
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11861 COURSEY BLVD
Address2:  
City: BATON ROUGE
State: LA
PostalCode: 708164404
CountryCode: US
TelephoneNumber: 2256128656
FaxNumber:  
Practice Location
Address1: 3233 S SHERWOOD FOREST BLVD STE 203B
Address2:  
City: BATON ROUGE
State: LA
PostalCode: 708162250
CountryCode: US
TelephoneNumber: 2252915492
FaxNumber: 2252915456
Other Information
ProviderEnumerationDate: 12/16/2018
LastUpdateDate: 10/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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