Provider Demographics
NPI:1194434357
Name:PARKER, SAMANTHA JO (RBT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:PARKER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 HURT ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-2311
Mailing Address - Country:US
Mailing Address - Phone:270-250-5070
Mailing Address - Fax:
Practice Address - Street 1:312 HURT ST
Practice Address - Street 2:UNIT C
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-2311
Practice Address - Country:US
Practice Address - Phone:270-250-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician