Provider Demographics
NPI:1083260723
Name:PARKER, WALTER ANTHONY III
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:ANTHONY
Last Name:PARKER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15169 WILD WIND PT # 92392
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-5558
Mailing Address - Country:US
Mailing Address - Phone:424-200-0049
Mailing Address - Fax:
Practice Address - Street 1:15169 WILD WIND PT # 92392
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-5558
Practice Address - Country:US
Practice Address - Phone:424-200-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician