Provider Demographics
NPI:1093926198
Name:PARKER, WILLIAM L III (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:PARKER
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:L
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2894 THORNAPPLE RIVER DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6857
Mailing Address - Country:US
Mailing Address - Phone:616-285-6080
Mailing Address - Fax:616-285-5466
Practice Address - Street 1:2894 THORNAPPLE RIVER DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6857
Practice Address - Country:US
Practice Address - Phone:616-285-6080
Practice Address - Fax:616-285-5466
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007243103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD14610Medicare ID - Type Unspecified