Provider Demographics
NPI:1689124505
Name:PARKER, ELLERY LEO III (LPCMH)
Entity Type:Individual
Prefix:MR
First Name:ELLERY
Middle Name:LEO
Last Name:PARKER
Suffix:III
Gender:M
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20859 WILKINS LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-5545
Mailing Address - Country:US
Mailing Address - Phone:302-236-7948
Mailing Address - Fax:
Practice Address - Street 1:900 HEALTH SERVICES DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-5786
Practice Address - Country:US
Practice Address - Phone:302-381-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health