Provider Demographics
NPI:1194366427
Name:PARKER, DANITRA MICHELL
Entity type:Individual
Prefix:
First Name:DANITRA
Middle Name:MICHELL
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 1:4955 JEFFREYS ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2284
Mailing Address - Country:US
Mailing Address - Phone:818-245-2964
Mailing Address - Fax:
Practice Address - Street 1:4955 JEFFREYS ST UNIT 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2284
Practice Address - Country:US
Practice Address - Phone:818-245-2964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician