Healthcare Provider Details

I. General information

NPI: 1699190314
Provider Name (Legal Business Name): STANLEY PARKER PH.D, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 DAKIN ST SUITE 101
LANSING MI
48912-1911
US

IV. Provider business mailing address

1001 DAKIN ST SUITE 101
LANSING MI
48912-1911
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-0414
  • Fax: 517-853-0415
Mailing address:
  • Phone: 517-853-0414
  • Fax: 517-853-0415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801012477
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: