Provider Demographics
NPI:1174852628
Name:PARKER, DANIEL RICHARD (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RICHARD
Last Name:PARKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 SOUTH PALM CANYON DRIVE
Mailing Address - Street 2:SUITE 7554
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264
Mailing Address - Country:US
Mailing Address - Phone:760-799-2004
Mailing Address - Fax:
Practice Address - Street 1:490 S. FARRELL DRIVE
Practice Address - Street 2:SUITE C207
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-799-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2016-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14606103TC0700X
MI6301010562103TC0700X
MA7511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS20645Medicare UPIN