Healthcare Provider Details

I. General information

NPI: 1275386708
Provider Name (Legal Business Name): KELLY HASSELBRING-PARKER LPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/05/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8810 S YALE AVE
TULSA OK
74137-3551
US

IV. Provider business mailing address

11323 S ADAMS ST
JENKS OK
74037-2515
US

V. Phone/Fax

Practice location:
  • Phone: 918-760-5243
  • Fax:
Mailing address:
  • Phone: 918-284-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCANDIDATE12119
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: