Active NPI
Mike Palk, L.P.C.
- Professional Counselor
- Cookeville, TN
National Provider Identifier
1083784516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0000001444
- Practice address
- 377 Short St
Suite D
Cookeville, TN 38501-7119 - Phone
- (931) 528-6167
- Fax
- (931) 526-9300
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0000001444 | TN | Primary |
Addresses
Primary practice location
377 Short St
Suite D
Cookeville, TN 38501-7119
Mailing address
PO Box 2916
Cookeville, TN 38502-2916
Phone (931) 528-6167
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3148479 | Other | TN | TN BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000001444 | TN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083784516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2916",
"city": "COOKEVILLE",
"state": "TN",
"postal_code": "385022916",
"telephone_number": "931-528-6167",
"fax_number": "931-526-9300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "377 SHORT ST",
"address_2": "SUITE D",
"city": "COOKEVILLE",
"state": "TN",
"postal_code": "385017119",
"telephone_number": "931-528-6167",
"fax_number": "931-526-9300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALK",
"first_name": "MIKE",
"name_prefix": "Mr.",
"credential": "L.P.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TN",
"license": "0000001444",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TN BLUE CROSS BLUE SHIELD",
"identifier": "3148479",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cookeville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.