Provider Demographics
NPI:1992284996
Name:PARKER RETHERFORD, PATTI MARIE (C 1800853 - TRNE)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:MARIE
Last Name:PARKER RETHERFORD
Suffix:
Gender:F
Credentials:C 1800853 - TRNE
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:RETHERFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:C 1800853 - TRNE
Mailing Address - Street 1:624 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3903
Mailing Address - Country:US
Mailing Address - Phone:740-687-0042
Mailing Address - Fax:740-687-6677
Practice Address - Street 1:624 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3903
Practice Address - Country:US
Practice Address - Phone:740-687-0042
Practice Address - Fax:740-687-6677
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1800853-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health