Organization
LAKE BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE PARKER PSYD, LP (PRESIDENT)
(573) 693-9090
Entity
Organization
Contact information
Practice address
5529B OSAGE BEACH PKWY, OSAGE BEACH, MO 65065-3023
(573) 693-9090
Mailing address
PO BOX 449, OSAGE BEACH, MO 65065-0449
(573) 693-9090
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490041266
—
MO
Enumeration date
03/08/2021
Last updated
04/21/2021
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