Provider Demographics
NPI:1386459584
Name:PARKS, AMANDA SHERRI (LAC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SHERRI
Last Name:PARKS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SHERRI
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:7979 E WILSHIRE DR APT 2006
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-2368
Mailing Address - Country:US
Mailing Address - Phone:336-655-9735
Mailing Address - Fax:
Practice Address - Street 1:6125 E INDIAN SCHOOL RD STE 1005
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5469
Practice Address - Country:US
Practice Address - Phone:480-877-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health