Healthcare Provider Details

I. General information

NPI: 1154358513
Provider Name (Legal Business Name): KAREN S PARKS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E TAMARACK RD
ALTUS OK
73521-1234
US

IV. Provider business mailing address

PO BOX 8190
ALTUS OK
73522-8190
US

V. Phone/Fax

Practice location:
  • Phone: 580-482-4095
  • Fax: 580-481-2499
Mailing address:
  • Phone: 580-482-4095
  • Fax: 580-481-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3496
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: