Provider Demographics
NPI:1801479704
Name:PARRISH, PHILLIP II
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:PARRISH
Suffix:II
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PHILLIP
Other - Middle Name:
Other - Last Name:PARRISH
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:87003 PROFESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-3400
Mailing Address - Country:US
Mailing Address - Phone:904-813-1190
Mailing Address - Fax:
Practice Address - Street 1:87003 PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-3400
Practice Address - Country:US
Practice Address - Phone:904-549-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty