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General NPI Number Information
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NPI Number | 1588085096
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Entity Type | Organization
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Legal Business Name | BONNIE PARKER PSYD LLC
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Dates
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Enumeration Date | 12/31/2013
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 8864 BIG LAKE RD
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City | CLARKSTON
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State | MI
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Zip | 48346-1010
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Country | US
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Telephone | 248-922-9222
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Fax | 248-922-9222
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Provider Business Mailing Address
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Address Line | 8864 BIG LAKE RD
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City | CLARKSTON
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State | MI
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Zip | 48346-1010
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Country | US
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Telephone | 248-922-9222
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Fax | 248-922-9222
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. BONNIE JO PARKER
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Credential | PSYD
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Telephone | 248-922-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6301013183
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License Number State | MI
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