MEDICARE: MRS. KIMBERLY ELIZABETH PARKER LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	346	KS
2	101YP2500X	Professional Counselor	4088	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	835346	OTHER	KS	BLUE CROSS BLUE SHIELD
2	15155	OTHER	KS	PREFERRED HEALTH SYSTEMS

General Provider Information

NPI Number	:	1861435844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ELIZABETH PARKER LCPC

Provider Business Mailing Address
First Line	:	650 S PEORIA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-4429
Country	:	US
Telephone Number	:	918-587-9471
Fax Number	:	918-560-1399

Provider Business Practice Location Address
First Line	:	650 S PEORIA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-4429
Country	:	US
Telephone Number	:	918-587-9471
Fax Number	:	918-560-1399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	06/13/2014

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