Healthcare Provider Details

I. General information

NPI: 1538544788
Provider Name (Legal Business Name): CALVIN DALE PARKER MA, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 S CLERMONT ST
CENTENNIAL CO
80122-2133
US

IV. Provider business mailing address

6709 S CLERMONT ST
CENTENNIAL CO
80122-2133
US

V. Phone/Fax

Practice location:
  • Phone: 432-266-8668
  • Fax:
Mailing address:
  • Phone: 432-266-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0017047
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number67007
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: