1821173030 NPI number — MRS. BEVERLY SUSAN PARKER DENNIS MFT

Table of content: MRS. BEVERLY SUSAN PARKER DENNIS MFT (NPI 1821173030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821173030 NPI number — MRS. BEVERLY SUSAN PARKER DENNIS MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER DENNIS
Provider First Name:
BEVERLY
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKER
Provider Other First Name:
BEVERLY
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821173030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2160 FLETCHER PKWY
Provider Second Line Business Mailing Address:
B-1
Provider Business Mailing Address City Name:
EL CAJON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92020-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-562-9000
Provider Business Mailing Address Fax Number:
619-670-5010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2160 FLETCHER PARKWAY
Provider Second Line Business Practice Location Address:
B-1
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-562-9000
Provider Business Practice Location Address Fax Number:
619-670-5010
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFT39404 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MFT39404 . This is a "LICENSE" identifier . This identifiers is of the category "OTHER".




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