Provider Demographics
NPI:1225397953
Name:PARISH, AMANDA R
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:R
Last Name:PARISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 SOUTHRIDGE RD APT 4
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5697
Mailing Address - Country:US
Mailing Address - Phone:918-607-8867
Mailing Address - Fax:
Practice Address - Street 1:173 SOUTHRIDGE RD APT 4
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5697
Practice Address - Country:US
Practice Address - Phone:918-607-8867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker