Provider Demographics
NPI:1083974588
Name:PARSONS, JERRY W (LSW, MSW, MLS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:W
Last Name:PARSONS
Suffix:
Gender:M
Credentials:LSW, MSW, MLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 STATE FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SOLSBERRY
Mailing Address - State:IN
Mailing Address - Zip Code:47459-8012
Mailing Address - Country:US
Mailing Address - Phone:317-500-0723
Mailing Address - Fax:
Practice Address - Street 1:3805 STATE FERRY RD
Practice Address - Street 2:
Practice Address - City:SOLSBERRY
Practice Address - State:IN
Practice Address - Zip Code:47459-8012
Practice Address - Country:US
Practice Address - Phone:317-500-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33005296A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN33005296AOtherSTATE OF INDIANA PLA