MEDICARE: KELSEY PARKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	19468	MT

General Provider Information

NPI Number	:	1053863597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY PARKE

Provider Business Mailing Address
First Line	:	719A SKYLA CT
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-1480
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 S RESERVE ST STE B
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-6401
Country	:	US
Telephone Number	:	406-282-1662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	09/27/2024

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Directions to “ KELSEY PARKE ” Practice Location

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