Provider Demographics
NPI:1730247438
Name:PARKER, BETH R (LCSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:R
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 VANDIVER DR
Mailing Address - Street 2:BLDG 6 SUITE 104
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3754
Mailing Address - Country:US
Mailing Address - Phone:573-442-5475
Mailing Address - Fax:573-442-5145
Practice Address - Street 1:409 VANDIVER DR
Practice Address - Street 2:BLDG 6 SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3754
Practice Address - Country:US
Practice Address - Phone:573-442-5475
Practice Address - Fax:573-442-5145
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0029301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical