MEDICARE: MR. MARVIN F PARKER CAS I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1811162126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARVIN F PARKER CAS I

Provider Business Mailing Address
First Line	:	2849 HILLTOP DR
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4328
Country	:	US
Telephone Number	:	530-391-4968
Fax Number	:

Provider Business Practice Location Address
First Line	:	893 SPRING ST
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4437
Country	:	US
Telephone Number	:	530-622-8193
Fax Number	:	530-622-4017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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