MEDICARE: DR. KERMIT E. PARKER JR. PHD, ABPP

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	103T00000X	Psychologist	22333	TX

General Provider Information

NPI Number	:	1801951140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERMIT E. PARKER JR. PHD, ABPP

Provider Business Mailing Address
First Line	:	43 MASON POND PL
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-3187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 LAKE FRONT CIR
Second Line	:	SUITE 150
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3613
Country	:	US
Telephone Number	:	936-321-1413
Fax Number	:	936-321-1413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	11/07/2007

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