Healthcare Provider Details

I. General information

NPI: 1689877904
Provider Name (Legal Business Name): JUDY LYNNE PARKINS MS,LBP,LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S BROADWAY AVE SUITE 408
ADA OK
74820-5807
US

IV. Provider business mailing address

124 S BROADWAY AVE SUITE 408
ADA OK
74820-5807
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-8773
  • Fax: 580-332-8774
Mailing address:
  • Phone: 580-332-8773
  • Fax: 580-332-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number513
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0006
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: