Active NPI
Kelley R. Parke, PHD, LPCC
- Professional Counselor
- Palo Alto, CA
National Provider Identifier
1134269541
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC 189
- Practice address
- 2425 Park Blvd # B102
Palo Alto, CA 94306-1931 - Phone
- (650) 722-2175
- NPI assigned
- Feb 7, 2007
- Last updated
- Aug 15, 2024
- Sex
- Male
- Sole proprietor
- No
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 | LPC 189 | CA | Primary |
Addresses
Primary practice location
2425 Park Blvd # B102
Palo Alto, CA 94306-1931
Mailing address
3790 El Camino Real # 1113
Palo Alto, CA 94306-3314
Phone (650) 722-2175
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 10, 2024 through Feb 10, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC 189 | CA | MD | Professional Counselor |
| 189 | CA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723680000000",
"number": "1134269541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3790 EL CAMINO REAL # 1113",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943063314",
"telephone_number": "650-722-2175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2425 PARK BLVD # B102",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943061931",
"telephone_number": "650-722-2175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARKE",
"first_name": "KELLEY",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "PHD, LPCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2024-08-15",
"certification_date": "2024-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "LPC 189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.