Provider Demographics
NPI:1740371319
Name:PARISHER, DARREL WAYNE (PHD)
Entity type:Individual
Prefix:DR
First Name:DARREL
Middle Name:WAYNE
Last Name:PARISHER
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 1:4204 GARDENDALE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-614-1188
Mailing Address - Fax:210-614-1188
Practice Address - Street 1:4204 GARDENDALE
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-1188
Practice Address - Fax:210-614-1188
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22398103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86752AOtherBLUE CROSS BLUE SHIELD
TX610276Medicare ID - Type Unspecified