MEDICARE: DR. KENNETH JOEL PARNELL PHD

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	103TC0700X	Clinical Psychologist	00004625	CO
2	103T00000X	Psychologist	PSY.0004625	CO

General Provider Information

NPI Number	:	1336663806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH JOEL PARNELL PHD

Provider Business Mailing Address
First Line	:	4103 BOARDWALK DR UNIT 200
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5930
Country	:	US
Telephone Number	:	970-413-2798
Fax Number	:

Provider Business Practice Location Address
First Line	:	4103 BOARDWALK DR STE 201
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5931
Country	:	US
Telephone Number	:	970-413-2798
Fax Number	:

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

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	03/10/2026

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