Provider Demographics
NPI:1689145971
Name:PARKS, BRET NICHOLAS (LCSW)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:NICHOLAS
Last Name:PARKS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-7470
Mailing Address - Country:US
Mailing Address - Phone:270-288-5036
Mailing Address - Fax:270-288-5082
Practice Address - Street 1:1118 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-7470
Practice Address - Country:US
Practice Address - Phone:270-288-5036
Practice Address - Fax:270-288-5082
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2537761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical