Provider Demographics
NPI:1306131750
Name:PARKS, CAROLYN RAE (MS)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:RAE
Last Name:PARKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 S HARVARD AVE STE 610
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3084
Mailing Address - Country:US
Mailing Address - Phone:918-407-5730
Mailing Address - Fax:918-223-3188
Practice Address - Street 1:4815 S HARVARD AVE STE 610
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3084
Practice Address - Country:US
Practice Address - Phone:918-407-5730
Practice Address - Fax:918-223-3188
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional