Provider Demographics
NPI:1730210931
Name:PARKER, CYNTHIA ELLEN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 UNION
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459
Mailing Address - Country:US
Mailing Address - Phone:541-756-2057
Mailing Address - Fax:541-751-7905
Practice Address - Street 1:1840 UNION AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3422
Practice Address - Country:US
Practice Address - Phone:541-756-2057
Practice Address - Fax:541-751-7905
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA010188Medicaid