Provider Demographics
NPI:1952372914
Name:PARK, KEVIN N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:N
Last Name:PARK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 S CURTICE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-1909
Mailing Address - Country:US
Mailing Address - Phone:720-381-4980
Mailing Address - Fax:303-347-2011
Practice Address - Street 1:5860 S CURTICE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1909
Practice Address - Country:US
Practice Address - Phone:720-381-4980
Practice Address - Fax:303-347-2011
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO011849103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist