1174549687 NPI number — CRAIG LUTHER PARKER LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174549687 NPI number — CRAIG LUTHER PARKER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
CRAIG
Provider Middle Name:
LUTHER
Provider Name Prefix Text:
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:
1174549687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 LAXTON RD
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24502-3144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-237-0155
Provider Business Mailing Address Fax Number:
434-237-0032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 LAXTON RD
Provider Second Line Business Practice Location Address:
SUITE 360
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24502-3144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-237-0155
Provider Business Practice Location Address Fax Number:
434-237-0032
Provider Enumeration Date:
07/15/2006

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: 101YP2500X , with the licence number:  0701002436 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 0717000406 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 17494 . This is a "MENNINGER CARE SYSTEMS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5406153 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117126 . This is a "BEHAVIORAL HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 081026 . This is a "SENTARA PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1054367 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 19555 . This is a "HRI PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 323150 . This is a "ANTHEM BC/BS PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1054367 . This is a "MCC BEHAVIORAL PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 57517 . This is a "HORIZONS PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 135110 . This is a "COMPSYCH PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 19497 . This is a "HRI PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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