Healthcare Provider Details

I. General information

NPI: 1437452406
Provider Name (Legal Business Name): EVAN DANIEL PARKS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S CORAL ST
KALKASKA MI
49646-2503
US

IV. Provider business mailing address

2153 WEALTHY ST SE STE 235
GRAND RAPIDS MI
49506-3033
US

V. Phone/Fax

Practice location:
  • Phone: 231-258-7777
  • Fax: 231-258-7786
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301006916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: