Provider Demographics
NPI:1487662565
Name:PARKER, PHILIP SCOTT (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:SCOTT
Last Name:PARKER
Suffix:
Gender:M
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 BRENT AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2725
Mailing Address - Country:US
Mailing Address - Phone:317-650-1105
Mailing Address - Fax:317-726-0714
Practice Address - Street 1:8135 BRENT AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2725
Practice Address - Country:US
Practice Address - Phone:317-650-1105
Practice Address - Fax:317-726-0714
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041153A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000207576OtherANTHEM PROVIDER NUMBER
IN675470Medicare ID - Type Unspecified