Provider Information for 1134762305
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POLLY PARKS LCSW
Sex: Female
NPI: 1134762305
Last Updated: 2022-03-22
Certification Date: 2022-03-22
Certification Date: 2022-03-22
Details
| Name | Value | ||||||||
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| NPI | 1134762305 | ||||||||
| Enumeration Date | 2019-10-21 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6710 JUNIPER CREST RD AGUA DULCE, CA 91390-3433 United States Phone: 661-618-2661 | Fax: | ||||||||
| Primary Practice Address | 40015 SIERRA HWY STE B280 PALMDALE, CA 93550-2143 United States Phone: 661-526-5061 | Fax: | ||||||||
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