Provider Demographics
NPI:1033240486
Name:PARKS, MISTY RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:RENEE
Last Name:PARKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-0964
Mailing Address - Country:US
Mailing Address - Phone:765-674-9070
Mailing Address - Fax:
Practice Address - Street 1:8226 DEVON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-1502
Practice Address - Country:US
Practice Address - Phone:317-691-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical