Provider Demographics
NPI:1821053125
Name:PARKER, MICHAEL W (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:PARKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 S SHACKLEFORD RD
Mailing Address - Street 2:#314
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3527
Mailing Address - Country:US
Mailing Address - Phone:501-312-9900
Mailing Address - Fax:501-801-0224
Practice Address - Street 1:650 S SHACKLEFORD RD
Practice Address - Street 2:#314
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3527
Practice Address - Country:US
Practice Address - Phone:501-312-9900
Practice Address - Fax:501-801-0224
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR93-10P101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S374Medicare ID - Type Unspecified