Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 115861 | TX |
NPI | 1598160327 |
---|---|
Provider Name | Jackson Parker |
First Address | Houston, TX 77030-4211 |
Second Address | Houston, TX 77030-4211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2014 |
Last Update Date | 22/10/2014 |