Provider Demographics
NPI:1780645838
Name:PARKER, GEORGE EDWARD (LSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EDWARD
Last Name:PARKER
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 WESTGLEN DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6733
Mailing Address - Country:US
Mailing Address - Phone:405-324-0521
Mailing Address - Fax:
Practice Address - Street 1:717 WESTGLEN DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6733
Practice Address - Country:US
Practice Address - Phone:405-324-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2160104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker