Provider Demographics
NPI:1083262141
Name:PRESTON, PARKER (LPCA, QMHP, CADCIII)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:
Last Name:PRESTON
Suffix:
Gender:M
Credentials:LPCA, QMHP, CADCIII
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:C
Other - Last Name:PRESTON
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:QMHP, CADCIII
Mailing Address - Street 1:704 SW FOREST AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2762
Mailing Address - Country:US
Mailing Address - Phone:541-324-0873
Mailing Address - Fax:
Practice Address - Street 1:704 SW FOREST AVE STE 101
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2762
Practice Address - Country:US
Practice Address - Phone:541-324-0873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-R-13101YA0400X
OR22-QMHPC-001173101YM0800X
ORR8792101YM0800X, 101YM0800X
CA11229101Y00000X
AZLAC-19606101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor