Active NPI
Kerry Max Park, LMFT
- Marriage & Family Therapist
- American Fork, UT
National Provider Identifier
1154592590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 126677-3902
- Practice address
- 21 N 490 W
American Fork, UT 84003-2264 - Phone
- (801) 592-7876
- NPI assigned
- Mar 13, 2008
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 126677-3902 | UT | Primary |
Addresses
Primary practice location
21 N 490 W
American Fork, UT 84003-2264
Mailing address
21 N 490 W
American Fork, UT 84003-2264
Phone (801) 592-7876
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 |
|---|---|---|---|
| 126677-3902 | UT | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454544000000",
"number": "1154592590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 N 490 W",
"city": "AMERICAN FORK",
"state": "UT",
"postal_code": "840032264",
"telephone_number": "801-592-7876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 N 490 W",
"city": "AMERICAN FORK",
"state": "UT",
"postal_code": "840032264",
"telephone_number": "801-592-7876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "KERRY",
"middle_name": "MAX",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-13",
"last_updated": "2016-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "UT",
"license": "126677-3902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in American Fork, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.