Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Keith Park

Individual provider Counselor · NPI 1710101092

Dr. Keith Park is a Counselor in Calimesa, California. Practices as a sole proprietor. Licensed in California and New Mexico.

Licensed in
CA, NM
In the registry since
2007
Specialties on file
2

Practice location Address checks out

908 Park Ave
Calimesa, CA 92320-1148
Phone: (909) 518-3886
Fax: (909) 790-9333
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Counselor (primary) Taxonomy 101Y00000X · Licence 0085201 (NM)
Psychologist Taxonomy 103T00000X · Licence PSY 18884 (CA)

Record details

NPI number1710101092
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedApril 11, 2007
Last updated in NPPESSeptember 11, 2025
Mailing addressPo Box 1526, Yucaipa, CA 92399-1435