Provider Demographics
NPI:1205492626
Name:PARRISH, MARK ROBERT (BS, CCM, CBIS)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ROBERT
Last Name:PARRISH
Suffix:
Gender:M
Credentials:BS, CCM, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-0281
Mailing Address - Country:US
Mailing Address - Phone:231-893-1462
Mailing Address - Fax:231-894-5844
Practice Address - Street 1:137 HOLTON WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-9543
Practice Address - Country:US
Practice Address - Phone:231-893-1462
Practice Address - Fax:231-894-5844
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4214878171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator