Provider Demographics
NPI:1548478910
Name:PARKS, PETER ALAN (PHD, LCP)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:PARKS
Suffix:
Gender:M
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 SW ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1233
Mailing Address - Country:US
Mailing Address - Phone:785-817-9136
Mailing Address - Fax:785-233-7089
Practice Address - Street 1:5315 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2371
Practice Address - Country:US
Practice Address - Phone:785-817-9136
Practice Address - Fax:785-233-7089
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health