Basic Information
| Provider Information | |||||||||
| NPI: | 1609063742 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1046 | ||||||||
| Address2: | |||||||||
| City: | CLARKSDALE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386141046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626277267 | ||||||||
| FaxNumber: | 6626275240 | ||||||||
| Practice Location | |||||||||
| Address1: | 1459 MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | TUNICA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623635999 | ||||||||
| FaxNumber: | 6626275240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2007 | ||||||||
| LastUpdateDate: | 10/03/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CH0540 | MS | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.