Individual
KATIE GUSSENHOVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7810 EAST 108TH STREET SOUTH, TULSA, OK 74133
(918) 561-6764
Mailing address
2920 S 129TH EAST AVE # 691208, TULSA, OK 74134-2400
(918) 813-8730
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-22-199752
OK
171M00000X
Case Manager/Care Coordinator
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Other
Enumeration date
10/20/2021
Last updated
01/24/2022
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