Provider Demographics
NPI:1215063508
Name:PARRISH, KEITH A (LCSW)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:PARRISH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1407
Mailing Address - Country:US
Mailing Address - Phone:317-447-1348
Mailing Address - Fax:317-885-9063
Practice Address - Street 1:898 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1407
Practice Address - Country:US
Practice Address - Phone:317-887-1348
Practice Address - Fax:317-885-9063
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004976A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000576117OtherANTHEM BLUE CROSS BLUE SHIELD
IN000000576117OtherANTHEM BLUE CROSS BLUE SHIELD