Healthcare Provider Details

I. General information

NPI: 1679919633
Provider Name (Legal Business Name): DEREK J PARKER M.A., M.S., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 1ST ST
DU BOIS PA
15801-3012
US

IV. Provider business mailing address

56 GRAHAM AVE
BROOKVILLE PA
15825-1403
US

V. Phone/Fax

Practice location:
  • Phone: 814-221-5744
  • Fax:
Mailing address:
  • Phone: 814-221-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: