Provider Demographics
NPI:1699190314
Name:PARKER, STANLEY (PHD, MSW)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 DAKIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1911
Mailing Address - Country:US
Mailing Address - Phone:517-853-0414
Mailing Address - Fax:517-853-0415
Practice Address - Street 1:1001 DAKIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1911
Practice Address - Country:US
Practice Address - Phone:517-853-0414
Practice Address - Fax:517-853-0415
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010124771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical