Provider Demographics
NPI:1518299064
Name:PARKS, NATALIE (PHD, BCBA-D)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 SCHOAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3194
Mailing Address - Country:US
Mailing Address - Phone:770-866-3909
Mailing Address - Fax:
Practice Address - Street 1:3859 FEE FEE RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2937
Practice Address - Country:US
Practice Address - Phone:770-866-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
GA003345103T00000X
MO2018028941103K00000X
MO2025009591103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist