Provider Demographics
NPI:1902540099
Name:PARSONS, FREDERICK JOSEPH (MSED, LMHCA)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:PARSONS
Suffix:
Gender:M
Credentials:MSED, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LAKE AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5351
Mailing Address - Country:US
Mailing Address - Phone:260-424-0411
Mailing Address - Fax:260-424-3530
Practice Address - Street 1:2200 LAKE AVE STE 260
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5351
Practice Address - Country:US
Practice Address - Phone:260-424-0411
Practice Address - Fax:260-424-3530
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001107A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health