Provider Demographics
NPI:1205272085
Name:PARKER, KRISTINE D (LMHC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:D
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5580
Mailing Address - Country:US
Mailing Address - Phone:772-224-2125
Mailing Address - Fax:772-224-2290
Practice Address - Street 1:1950 SE PORT ST LUCIE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5580
Practice Address - Country:US
Practice Address - Phone:772-224-2125
Practice Address - Fax:772-224-2290
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health