Provider Demographics
NPI:1992171946
Name:CORSA PARKER, TRACY LYNN (LMHC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:CORSA PARKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 FERNDALE LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9110
Mailing Address - Country:US
Mailing Address - Phone:352-459-5747
Mailing Address - Fax:
Practice Address - Street 1:7 FLORIDA PARK DR N
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3865
Practice Address - Country:US
Practice Address - Phone:352-459-5747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health