Provider Demographics
NPI:1992817050
Name:PARKER, TRESAVON DELANEY III (MA, LLP)
Entity type:Individual
Prefix:MR
First Name:TRESAVON
Middle Name:DELANEY
Last Name:PARKER
Suffix:III
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29403 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2829
Mailing Address - Country:US
Mailing Address - Phone:248-622-0552
Mailing Address - Fax:
Practice Address - Street 1:13213 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-6302
Practice Address - Country:US
Practice Address - Phone:586-939-4518
Practice Address - Fax:586-939-4783
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIP626802139810103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical