Provider Demographics
NPI:1962193631
Name:PARKE, TRINA (MSW, CSW)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:PARKE
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 E 200 N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2834
Mailing Address - Country:US
Mailing Address - Phone:435-610-1696
Mailing Address - Fax:435-226-4449
Practice Address - Street 1:192 E 200 N STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2834
Practice Address - Country:US
Practice Address - Phone:435-610-1696
Practice Address - Fax:435-226-4449
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13404860-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical