MEDICARE: DR. GREGORY PARKS PH.D.

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	103T00000X	Psychologist	33260	TX
2	103T00000X	Psychologist	1235	OK

General Provider Information

NPI Number	:	1306127048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY PARKS PH.D.

Provider Business Mailing Address
First Line	:	6608 N WESTERN AVE
Second Line	:	STE. 453
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7326
Country	:	US
Telephone Number	:	405-696-7795
Fax Number	:	855-861-6281

Provider Business Practice Location Address
First Line	:	6608 N WESTERN AVE
Second Line	:	STE. 453
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7326
Country	:	US
Telephone Number	:	405-696-7795
Fax Number	:	855-861-6281

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

Provider Enumeration Date	:	09/08/2011
Last Update Date	:	04/19/2017

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Directions to “ DR. GREGORY PARKS PH.D.” Practice Location

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