Provider Demographics
NPI:1194149088
Name:PARKER, REBECKA
Entity type:Individual
Prefix:
First Name:REBECKA
Middle Name:
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 1:2152 S. VINEYARD
Mailing Address - Street 2:BLD. 4 STE. 110
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-7135
Mailing Address - Country:US
Mailing Address - Phone:385-449-1618
Mailing Address - Fax:
Practice Address - Street 1:2152 S. VINEYARD
Practice Address - Street 2:BLD. 4 STE. 110
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-7135
Practice Address - Country:US
Practice Address - Phone:385-449-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8803479-35021041C0700X
AZLCSW-200321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical