Individual
MYRA SHENELLE PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TCM
Contact information
Practice address
516 RAIN GARDEN WAY, LEXINGTON, KY 40511-1849
(859) 285-5352
Mailing address
516 RAIN GARDEN WAY, LEXINGTON, KY 40511-1849
(859) 285-5352
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
KY
251S00000X
Community/Behavioral Health Agency
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00406413
DRIVER'S LICENSE
KY
Enumeration date
07/09/2025
Last updated
07/11/2025
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