1861662637 NPI number — MR. VALERY TODD PARRISH LPC

Table of content: MR. VALERY TODD PARRISH LPC (NPI 1861662637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861662637 NPI number — MR. VALERY TODD PARRISH LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARRISH
Provider First Name:
VALERY
Provider Middle Name:
TODD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861662637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 HICKORY STREET STE 404
Provider Second Line Business Mailing Address:
HIGHLAND RIVERS CSB
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30720-2312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-270-5033
Provider Business Mailing Address Fax Number:
706-370-7749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 NORTH DIVISION STREET NW
Provider Second Line Business Practice Location Address:
HIGHLAND RIVERS CSB, FLOYD COUNTY, ADULT MENTAL HEALTH
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30165-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-802-5437
Provider Business Practice Location Address Fax Number:
706-802-5440
Provider Enumeration Date:
03/07/2008

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: 101YP2500X , with the licence number:  LPC003930 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC3930 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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