Basic Information
| Provider Information | |||||||||
| NPI: | 1790724946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PARKER | ||||||||
| OtherFirstName: | CHRIST | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3030 NORTH ST | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777021433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002307525 | ||||||||
| FaxNumber: | 8664045622 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 S EDMONDS LN | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750673511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143963960 | ||||||||
| FaxNumber: | 2143963962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C003538 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.