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Individual

DIANA LYNN PARENT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2325 S HARVARD AVE, TULSA, OK 74114-3300
(918) 599-7404
(918) 382-1881
Mailing address
5310 E 31ST ST STE 7, TULSA, OK 74135-5014
(918) 599-7404
(918) 777-9016

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
175T00000X
Peer Specialist
U080054193
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1174033039
OK
Enumeration date
10/05/2017
Last updated
12/28/2023
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