Provider Demographics
NPI:1083144349
Name:PARKS, JADORA BREAL
Entity type:Individual
Prefix:MISS
First Name:JADORA
Middle Name:BREAL
Last Name:PARKS
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 1:3460 RIVER BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-2000
Mailing Address - Country:US
Mailing Address - Phone:502-296-6734
Mailing Address - Fax:
Practice Address - Street 1:214 BRECKENRIDGE LN STE 205
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3879
Practice Address - Country:US
Practice Address - Phone:502-354-7876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2025-10-02
Deactivation Date:2022-06-17
Deactivation Code:
Reactivation Date:2022-08-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician