Provider Demographics
NPI:1760014518
Name:PARKER, CHAD A (DSW, LMSW, LPC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:A
Last Name:PARKER
Suffix:
Gender:M
Credentials:DSW, LMSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-2934
Mailing Address - Country:US
Mailing Address - Phone:662-397-9072
Mailing Address - Fax:
Practice Address - Street 1:1801 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-2934
Practice Address - Country:US
Practice Address - Phone:662-397-9072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional