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General NPI Number Information
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NPI Number | 1194156414
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Entity Type | Individual
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Provider Name | DR. MICHAEL JAMES PARKER
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Gender | Male
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 1300 CIRCLE DR
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City | FORT WORTH
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State | TX
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Zip | 76119-8113
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Country | US
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Telephone | 817-569-4801
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Fax | 817-569-4108
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Provider Business Mailing Address
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Address Line | 1300 CIRCLE DR
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City | FORT WORTH
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State | TX
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Zip | 76119-8113
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Country | US
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Telephone | 817-569-4801
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Fax | 817-569-4108
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 31136
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License Number State | TX
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