MEDICARE: G PARKS PHD PLLC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center	1235	OK

General Provider Information

NPI Number	:	1427557891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G PARKS PHD PLLC

Provider Business Mailing Address
First Line	:	6608 N WESTERN AVE # 453
Second Line	:
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 # 453
Second Line	:
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	:	PSYCHOLOGIST
Name	:	DR. GREGORY PARKS
Credential	:	PHD
Telephone Number	:	405-696-7795

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	02/12/2018

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