Provider Demographics
NPI:1427557891
Name:G PARKS PHD PLLC
Entity Type:Organization
Organization Name:G PARKS PHD PLLC
Other - Org Name:DR. GREGORY PARKS
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-696-7795
Mailing Address - Street 1:6608 N WESTERN AVE # 453
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7326
Mailing Address - Country:US
Mailing Address - Phone:405-696-7795
Mailing Address - Fax:855-861-6281
Practice Address - Street 1:6608 N WESTERN AVE # 453
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7326
Practice Address - Country:US
Practice Address - Phone:405-696-7795
Practice Address - Fax:855-861-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1235261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health