Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 90 | KS |
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 90 | OK |
N | 101YP2500X | Professional Counselor | 882 | KS |
NPI | 1003301888 |
---|---|
Provider Name | Shelly Jane Parkman |
First Address | Cushing, OK 74023-4406 |
Second Address | Cushing, OK 74023-4406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2018 |
Last Update Date | 25/06/2018 |