Healthcare Provider Details

I. General information

NPI: 1740412196
Provider Name (Legal Business Name): JAMES WILLIAM PARKER MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 CAMINO DEL RIO N SUITE 211
SAN DIEGO CA
92108-1621
US

IV. Provider business mailing address

2650 CAMINO DEL RIO N SUITE 211
SAN DIEGO CA
92108-1621
US

V. Phone/Fax

Practice location:
  • Phone: 858-952-8196
  • Fax: 619-297-9108
Mailing address:
  • Phone: 858-952-8196
  • Fax: 619-297-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number47548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: