Provider Demographics
NPI:1861435844
Name:PARKER, KIMBERLY ELIZABETH (LCPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:GIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-560-1399
Practice Address - Street 1:650 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS346101YP2500X
OK4088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS835346OtherBLUE CROSS BLUE SHIELD
KS15155OtherPREFERRED HEALTH SYSTEMS