Healthcare Provider Details

I. General information

NPI: 1093926198
Provider Name (Legal Business Name): WILLIAM L PARKER III PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WILLIAM L PARKER PHD

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2894 THORNAPPLE RIVER DR SE
GRAND RAPIDS MI
49546-6857
US

IV. Provider business mailing address

2894 THORNAPPLE RIVER DR SE
GRAND RAPIDS MI
49546-6857
US

V. Phone/Fax

Practice location:
  • Phone: 616-285-6080
  • Fax: 616-285-5466
Mailing address:
  • Phone: 616-285-6080
  • Fax: 616-285-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301007243
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: