Provider Demographics
NPI:1558615674
Name:PARKER, MARCIA LYNN
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNN
Last Name:PARKER
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 1:14900 J ST
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:OK
Mailing Address - Zip Code:74941-6550
Mailing Address - Country:US
Mailing Address - Phone:918-966-3246
Mailing Address - Fax:918-966-2162
Practice Address - Street 1:14900 J ST
Practice Address - Street 2:
Practice Address - City:KEOTA
Practice Address - State:OK
Practice Address - Zip Code:74941-6550
Practice Address - Country:US
Practice Address - Phone:918-966-3246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10-22-12101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor