Provider Demographics
NPI:1962835173
Name:PARKER, STACY M (BS)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:M
Last Name:PARKER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S WASHITA AVE
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-7820
Mailing Address - Country:US
Mailing Address - Phone:405-665-4385
Mailing Address - Fax:405-665-6396
Practice Address - Street 1:1523 CHICKASAW BLVD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1826
Practice Address - Country:US
Practice Address - Phone:918-429-6476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health