=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881546612
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JERELL PARKER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2026
-----------------------------------------------------
Last Update Date | 02/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 GRAND AVE STE 204
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94610-3554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-224-5123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2163 ALDENGATE WAY UNIT 326
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94557-1007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-994-8410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 161573
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------