Provider Demographics
NPI:1225116494
Name:PARHAM, KEITH JR
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:PARHAM
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13682 RANDA PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-3497
Mailing Address - Country:US
Mailing Address - Phone:205-799-4231
Mailing Address - Fax:205-391-9766
Practice Address - Street 1:5690 WATERMELON RD STE 310
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5009
Practice Address - Country:US
Practice Address - Phone:205-391-9777
Practice Address - Fax:205-391-9766
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1504101YM0800X
AL52106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL#10710Medicare UPIN