Basic Information
| Provider Information | |||||||||
| NPI: | 1174730675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKES | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MA, JD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7406 27TH ST W | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534607248 | ||||||||
| FaxNumber: | 2535654409 | ||||||||
| Practice Location | |||||||||
| Address1: | 7406 27TH ST W | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534607248 | ||||||||
| FaxNumber: | 2535654409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 07/30/2009 | ||||||||
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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 | 106H00000X | LF60064473 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | LH60064471 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.