Provider Demographics
NPI:1144481284
Name:PARKS, ANDREA (LMFT, LPC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-3001
Mailing Address - Country:US
Mailing Address - Phone:318-878-8656
Mailing Address - Fax:318-878-6321
Practice Address - Street 1:501 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-3001
Practice Address - Country:US
Practice Address - Phone:318-878-5686
Practice Address - Fax:318-878-6321
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1024106H00000X
LA3070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA171M00000XMedicaid