Provider Demographics
NPI:1801008693
Name:PARISH, MICHAEL S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:PARISH
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 1:1421 SE 4TH AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1900
Mailing Address - Country:US
Mailing Address - Phone:954-524-5244
Mailing Address - Fax:954-524-9444
Practice Address - Street 1:1421 SE 4TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1900
Practice Address - Country:US
Practice Address - Phone:954-524-5244
Practice Address - Fax:954-524-9444
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6021103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3608YMedicare PIN