Provider Demographics
NPI:1669856233
Name:PARKS, HOLLY LYNNE (MA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNNE
Last Name:PARKS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19730 N HARRAH RD
Mailing Address - Street 2:
Mailing Address - City:LUTHER
Mailing Address - State:OK
Mailing Address - Zip Code:73054-9818
Mailing Address - Country:US
Mailing Address - Phone:405-820-6986
Mailing Address - Fax:405-582-2931
Practice Address - Street 1:11032 QUAIL CREEK RD
Practice Address - Street 2:STE 265
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6219
Practice Address - Country:US
Practice Address - Phone:405-582-2929
Practice Address - Fax:405-582-2931
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCAND101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional