Organization
GRAVEL ROAD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER BREWINGTON (CEO)
(918) 766-6368
Entity
Organization
Contact information
Practice address
3820 SILVER LAKE VW, BARTLESVILLE, OK 74006-7341
(918) 766-6368
Mailing address
3820 SILVER LAKE VW, BARTLESVILLE, OK 74006-7341
(918) 766-6368
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
02/02/2012
Last updated
02/02/2012
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