Provider Demographics
NPI:1801951140
Name:PARKER, KERMIT E JR (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:KERMIT
Middle Name:E
Last Name:PARKER
Suffix:JR
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MASON POND PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 LAKE FRONT CIR
Practice Address - Street 2:SUITE 150
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3613
Practice Address - Country:US
Practice Address - Phone:936-321-1413
Practice Address - Fax:936-321-1413
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T62YMedicare PIN