Healthcare Provider Details

I. General information

NPI: 1528276995
Provider Name (Legal Business Name): CHRISTOPHER PARKER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3287 RACQUET CLUB DR UNIT A
TRAVERSE CITY MI
49684-4702
US

IV. Provider business mailing address

PO BOX 428
CADILLAC MI
49601-0428
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-0355
  • Fax: 231-935-0360
Mailing address:
  • Phone: 231-775-6076
  • Fax: 231-775-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801070351
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: