Provider Demographics
NPI:1780845719
Name:PARKER, JIM L
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:L
Last Name:PARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W HENSLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-2519
Mailing Address - Country:US
Mailing Address - Phone:918-337-6007
Mailing Address - Fax:918-287-9004
Practice Address - Street 1:610 W HENSLEY BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-2519
Practice Address - Country:US
Practice Address - Phone:918-337-6007
Practice Address - Fax:918-287-9004
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK365101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK365OtherCADC