Provider Demographics
NPI:1639296023
Name:PARKER, TERRY RAY (MS)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:RAY
Last Name:PARKER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21164
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-1164
Mailing Address - Country:US
Mailing Address - Phone:918-916-2309
Mailing Address - Fax:
Practice Address - Street 1:3033 N WALNUT AVE
Practice Address - Street 2:EAST BUILDING
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2832
Practice Address - Country:US
Practice Address - Phone:918-916-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK623101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)