Provider Demographics
NPI:1851064976
Name:PARKER, MAYA C
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:C
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23110 WELLINGTON CRES APT 201
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3549
Mailing Address - Country:US
Mailing Address - Phone:586-665-3047
Mailing Address - Fax:
Practice Address - Street 1:23110 WELLINGTON CRES APT 201
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3549
Practice Address - Country:US
Practice Address - Phone:586-665-3047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YM0800X
156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health