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General NPI Number Information
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NPI Number | 1205148855
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Entity Type | Individual
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Provider Name | JERE FRANCIS PARKER L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 2511 E 46TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-2460
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Country | US
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Telephone | 317-590-4498
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Fax | 317-297-6539
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Provider Business Mailing Address
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Address Line | 3250 MANNING RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46228-2862
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Country | US
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Telephone | 317-297-7543
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Fax | 317-297-6539
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87000092A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3400-2520A
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License Number State | IN
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