Provider Demographics
NPI:1093068660
Name:PARRISH, MELVIN LORENZO (MELVIN PARRISH)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:LORENZO
Last Name:PARRISH
Suffix:
Gender:M
Credentials:MELVIN PARRISH
Other - Prefix:MR
Other - First Name:MELVIN
Other - Middle Name:
Other - Last Name:PARRISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MELVIN PARRISH
Mailing Address - Street 1:3893 SIENNA GREENS TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-7302
Mailing Address - Country:US
Mailing Address - Phone:954-821-4333
Mailing Address - Fax:954-731-6640
Practice Address - Street 1:547 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-8113
Practice Address - Country:US
Practice Address - Phone:954-462-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2046101YA0400X
FL6964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6964OtherLMHC
FL2046OtherCAP