Provider Demographics
NPI:1104446608
Name:PARKER, JEREMY (MS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W ADAMS ST STE 514
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-5108
Mailing Address - Country:US
Mailing Address - Phone:312-578-9990
Mailing Address - Fax:312-275-7663
Practice Address - Street 1:101 N 1ST AVE STE 2310
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1902
Practice Address - Country:US
Practice Address - Phone:312-578-9990
Practice Address - Fax:312-275-7663
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty