Provider Demographics
NPI:1376536052
Name:PARKER, MARLENE (HSPP)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 NORTHPARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-9700
Mailing Address - Country:US
Mailing Address - Phone:260-356-2875
Mailing Address - Fax:260-358-0611
Practice Address - Street 1:850 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3163
Practice Address - Country:US
Practice Address - Phone:574-267-7169
Practice Address - Fax:574-269-3995
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041950A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN169430BMedicare ID - Type UnspecifiedPROVIDER ID