Provider Demographics
NPI:1609128677
Name:PARKS, LONNIE R (BHRS)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:R
Last Name:PARKS
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 1/2 S.E. 2ND
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-0000
Mailing Address - Country:US
Mailing Address - Phone:580-298-1199
Mailing Address - Fax:580-298-1199
Practice Address - Street 1:106 1/2 S.E. 2ND
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-0000
Practice Address - Country:US
Practice Address - Phone:580-298-1199
Practice Address - Fax:580-298-1199
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation