Provider Demographics
NPI:1861292534
Name:PARKS, JILLIAN ELISE (PMHNP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ELISE
Last Name:PARKS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 INGLEWOOD BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6249
Mailing Address - Country:US
Mailing Address - Phone:424-532-1552
Mailing Address - Fax:888-247-7249
Practice Address - Street 1:5555 INGLEWOOD BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6249
Practice Address - Country:US
Practice Address - Phone:424-532-1552
Practice Address - Fax:888-247-7249
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034328363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health