Provider Demographics
NPI:1134833429
Name:PARKER, RONNELL DAULYNN (LMHC)
Entity type:Individual
Prefix:
First Name:RONNELL
Middle Name:DAULYNN
Last Name:PARKER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16626 92ND AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2213
Mailing Address - Country:US
Mailing Address - Phone:253-906-3629
Mailing Address - Fax:
Practice Address - Street 1:9407 NE VANCOUVER MALL DR # 1041052
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6191
Practice Address - Country:US
Practice Address - Phone:253-906-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61002973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health