Provider Demographics
NPI:1063800308
Name:PERKINS, MOLLY (MS LPC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:PANICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 S BICKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2756
Mailing Address - Country:US
Mailing Address - Phone:405-595-0135
Mailing Address - Fax:405-225-7472
Practice Address - Street 1:221 S BICKFORD AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2756
Practice Address - Country:US
Practice Address - Phone:405-595-0135
Practice Address - Fax:405-225-7472
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK7104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200723100AMedicaid