=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699190314
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STANLEY PARKER PH.D, MSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2014
-----------------------------------------------------
Last Update Date | 03/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 DAKIN ST SUITE 101
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48912-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-853-0414
-----------------------------------------------------
Fax | 517-853-0415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 DAKIN ST SUITE 101
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48912-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-853-0414
-----------------------------------------------------
Fax | 517-853-0415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801012477
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------