Provider Demographics
NPI:1689877904
Name:PARKINS, JUDY LYNNE (MS,LBP,LADC)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LYNNE
Last Name:PARKINS
Suffix:
Gender:F
Credentials:MS,LBP,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S BROADWAY AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5807
Mailing Address - Country:US
Mailing Address - Phone:580-332-8773
Mailing Address - Fax:580-332-8774
Practice Address - Street 1:124 S BROADWAY AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5807
Practice Address - Country:US
Practice Address - Phone:580-332-8773
Practice Address - Fax:580-332-8774
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK513101YA0400X
OK0006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)