Individual
MOSS GAWAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2548 E KENOSHA ST, BROKEN ARROW, OK 74014-6712
(918) 355-0993
Mailing address
4103 S YALE AVE STE B, TULSA, OK 74135-6002
(918) 382-7300
(918) 382-7302
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/26/2023
Last updated
02/18/2025
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