Provider Demographics
NPI:1417078072
Name:PARKER, KEITH DANIEL
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DANIEL
Last Name:PARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:24077 STATE HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8519
Mailing Address - Country:US
Mailing Address - Phone:530-265-9057
Mailing Address - Fax:530-292-3803
Practice Address - Street 1:24077 STATE HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-8519
Practice Address - Country:US
Practice Address - Phone:530-265-9057
Practice Address - Fax:530-292-3803
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT39058106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist