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Individual
MR. GORDON RAY WHITEWOLF
Active
Individual
MR. GORDON RAY WHITEWOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LBP
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
386
OK
101YM0800X
Mental Health Counselor
Primary
0216
OK
Other
Enumeration date
12/01/2008
Last updated
12/01/2008
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