| Dr Keith Park, | |
|
908 Park Ave, Calimesa, CA 92320-1148 | |
| (909) 518-3886 | |
| (909) 790-9333 |
| Full Name | Dr Keith Park |
|---|---|
| Gender | Male |
| Speciality | Counselor |
| Location | 908 Park Ave, Calimesa, California |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710101092 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 0085201 (New Mexico) | Primary |
| 103T00000X | Psychologist | PSY 18884 (California) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Keith Park, Po Box 1526, Yucaipa, CA 92399-1435 Ph: (909) 518-3886 | Dr Keith Park, 908 Park Ave, Calimesa, CA 92320-1148 Ph: (909) 518-3886 |
Denise Lafourcade, Counselor Medicare: Not Enrolled in Medicare Practice Location: 800 Mustang Way, Calimesa, CA 92320 Phone: 909-790-8008 | |
Sarah Elizabeth Vanwaardenburg, PPS Counselor Medicare: Not Enrolled in Medicare Practice Location: 800 Mustang Way, Calimesa, CA 92320 Phone: 909-790-8008 | |
Monique Kassandra Chaidez, APCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 800 Mustang Way, Calimesa, CA 92320 Phone: 909-790-8008 | |
Candace Lauren Deese, MS Counselor Medicare: Not Enrolled in Medicare Practice Location: 1096 Calimesa Blvd Ste 208, Calimesa, CA 92320 Phone: 909-372-0683 |