Individual
JUSTIN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
37283 SWAMP RD STE 803, PRAIRIEVILLE, LA 70769-3329
(225) 254-9589
(222) 208-7267
Mailing address
PO BOX 640040, PIKE ROAD, AL 36064-0040
(225) 254-9589
(225) 208-7267
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/21/2017
Last updated
10/23/2025
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