Provider Demographics
NPI:1235404229
Name:PARRISH, MARK JACKSON
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JACKSON
Last Name:PARRISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E PATRIOT BLVD APT 286
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2354
Mailing Address - Country:US
Mailing Address - Phone:775-276-9124
Mailing Address - Fax:
Practice Address - Street 1:530 E PATRIOT BLVD APT 286
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2354
Practice Address - Country:US
Practice Address - Phone:775-276-9124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health