Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301007243 | MI |
NPI | 1093926198 |
---|---|
Provider Name | Dr. William L Parker III |
First Address | Grand Rapids, MI 49546-6857 |
Second Address | Grand Rapids, MI 49546-6857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |