Provider Demographics
NPI:1861655763
Name:PARKER, KEITH SYKES
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:SYKES
Last Name:PARKER
Suffix:
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 1:12022 BIRCH AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3931
Mailing Address - Country:US
Mailing Address - Phone:310-676-2468
Mailing Address - Fax:
Practice Address - Street 1:4920 S. AVALON BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:213-607-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily