MEDICARE: DRS. MOOREHEAD, PARISH AND ASSOC., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY4324	FL
2	103TC0700X	Clinical Psychologist	PY6021	FL

General Provider Information

NPI Number	:	1659397289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. MOOREHEAD, PARISH AND ASSOC., P.A.

Provider Business Mailing Address
First Line	:	1201 E BROWARD BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2133
Country	:	US
Telephone Number	:	954-524-5244
Fax Number	:	954-779-7994

Provider Business Practice Location Address
First Line	:	1201 E BROWARD BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2133
Country	:	US
Telephone Number	:	954-524-5244
Fax Number	:	954-779-7994

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. MICHAEL PARISH
Credential	:	PSY.D.
Telephone Number	:	954-524-5244

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	08/22/2020

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