Provider Demographics
NPI:1386124576
Name:SALLIE PARKER LMSW, PLLC
Entity type:Organization
Organization Name:SALLIE PARKER LMSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-476-1973
Mailing Address - Street 1:3106 FAWNMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9666
Mailing Address - Country:US
Mailing Address - Phone:734-476-1973
Mailing Address - Fax:
Practice Address - Street 1:2035 HOGBACK RD
Practice Address - Street 2:SUITE 207
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9666
Practice Address - Country:US
Practice Address - Phone:734-476-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801058484261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821210238OtherNPI 1
MI64097177Medicaid