Individual
DR. MICHAEL JAMES PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1300 CIRCLE DR, FORT WORTH, TX 76119-8113
(817) 569-4801
(817) 569-4108
Mailing address
1300 CIRCLE DR, FORT WORTH, TX 76119-8113
(817) 569-4801
(817) 569-4108
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
31136
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
330146701
—
TX
01
—
330146702
MEDICAID CSHC
TX
01
—
88933A
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/12/2013
Last updated
07/17/2014
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