Provider Demographics
NPI:1033206628
Name:PARRIS, JON DANIEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:DANIEL
Last Name:PARRIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 WINCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-0861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2517 BEMISS RD
Practice Address - Street 2:SUITE D
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1963
Practice Address - Country:US
Practice Address - Phone:229-245-6591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional