Provider Demographics
NPI:1629422175
Name:PARKER, MARC ROBERT (PSYD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ROBERT
Last Name:PARKER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83837
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97283-0837
Mailing Address - Country:US
Mailing Address - Phone:503-227-3090
Mailing Address - Fax:971-339-5269
Practice Address - Street 1:1717 NE 42ND AVE STE 2103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1570
Practice Address - Country:US
Practice Address - Phone:503-227-3090
Practice Address - Fax:971-339-5269
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61009916103TC0700X
OR3372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical