Provider Demographics
NPI:1740412196
Name:PARKER, JAMES WILLIAM (MFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:PARKER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 CAMINO DEL RIO N
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1621
Mailing Address - Country:US
Mailing Address - Phone:858-952-8196
Mailing Address - Fax:619-297-9108
Practice Address - Street 1:2650 CAMINO DEL RIO N
Practice Address - Street 2:SUITE 211
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1621
Practice Address - Country:US
Practice Address - Phone:858-952-8196
Practice Address - Fax:619-297-9108
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist