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General NPI Number Information
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NPI Number | 1134269541
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Entity Type | Individual
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Provider Name | KELLEY R. PARKE PHD, LPCC
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 2425 PARK BLVD # B102
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City | PALO ALTO
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State | CA
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Zip | 94306-1931
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Country | US
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Telephone | 650-722-2175
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Fax |
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Provider Business Mailing Address
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Address Line | 3790 EL CAMINO REAL # 1113
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City | PALO ALTO
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State | CA
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Zip | 94306-3314
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Country | US
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Telephone | 650-722-2175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC 189
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License Number State | CA
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