Healthcare Provider Details

I. General information

NPI: 1215063508
Provider Name (Legal Business Name): KEITH A PARRISH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 E MAIN ST
GREENWOOD IN
46143-1407
US

IV. Provider business mailing address

898 E MAIN ST
GREENWOOD IN
46143-1407
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-1348
  • Fax: 317-885-9063
Mailing address:
  • Phone: 317-447-1348
  • Fax: 317-885-9063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004976A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: