Provider Demographics
NPI:1639502545
Name:BONNY PARKHURST, LPC, PLLC
Entity type:Organization
Organization Name:BONNY PARKHURST, LPC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / LICENSED COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKHURST
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:918-202-9432
Mailing Address - Street 1:4524 S KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6536
Mailing Address - Country:US
Mailing Address - Phone:918-292-9432
Mailing Address - Fax:
Practice Address - Street 1:1201 E 33RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2017
Practice Address - Country:US
Practice Address - Phone:918-292-9432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5006302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization