| Mary Collette Parks, LBS, LPC | |
|
781 Far Hills Dr Ste 600, New Freedom, PA 17349-8404 | |
| (717) 812-2560 | |
| (717) 812-2569 |
| Full Name | Mary Collette Parks |
|---|---|
| Gender | Female |
| Speciality | Counselor - Professional |
| Location | 781 Far Hills Dr Ste 600, New Freedom, Pennsylvania |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619593639 | NPI | - | NPPES |
| BH002981 | Other | PA | LICENSED BEHAVIORAL SPECIALIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | BH002981 (Pennsylvania) | Secondary |
| 101YP2500X | Counselor - Professional | PC012855 (Pennsylvania) | Primary |
| Entity Name | Wellspan Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669770004 PECOS PAC ID: 1951213115 Enrollment ID: O20040220000815 |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Collette Parks, LBS, LPC 601 Memory Ln, York, PA 17402-2231 Ph: (717) 851-1405 | Mary Collette Parks, LBS, LPC 781 Far Hills Dr Ste 600, New Freedom, PA 17349-8404 Ph: (717) 812-2560 |
Crystal Derose, Counselor Medicare: Medicare Enrolled Practice Location: 781 Far Hills Dr Ste 600, New Freedom, PA 17349 Phone: 717-812-2560 Fax: 717-812-2569 | |
Jessica Rae Conrad, LPC Counselor Medicare: Medicare Enrolled Practice Location: 781 Far Hills Dr, New Freedom, PA 17349 Phone: 717-812-2560 | |
Ms. Holly R Wade, LCPC, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 15394 Revere Dr, New Freedom, PA 17349 Phone: 443-904-2715 |