Basic Information
Provider Information | |||||||||
NPI: | 1215271135 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PARKER | ||||||||
FirstName: | JESSICA | ||||||||
MiddleName: | KATHLEEN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHD, LMHC, LCPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PARKER | ||||||||
OtherFirstName: | JESSICA | ||||||||
OtherMiddleName: | RUST | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 325 E PIONEER | ||||||||
Address2: |   | ||||||||
City: | PUYALLUP | ||||||||
State: | WA | ||||||||
PostalCode: | 983723265 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2536978400 | ||||||||
FaxNumber: | 2536973730 | ||||||||
Practice Location | |||||||||
Address1: | 134 8TH AVE N | ||||||||
Address2: |   | ||||||||
City: | ALGONA | ||||||||
State: | WA | ||||||||
PostalCode: | 980014301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2085124769 | ||||||||
FaxNumber: | 2532681121 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/15/2012 | ||||||||
LastUpdateDate: | 08/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | LH60588445 | 01 | WA | LICENSED MENTAL HEALTH COUNSELOR | OTHER | LCPC-8023 | 01 | ID | LICENSED CLINICAL PROFESSIONAL COUNSELOR | OTHER |