Individual
GERRELL THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
217 NW 40TH ST, OKLAHOMA CITY, OK 73118-8417
(405) 822-3452
Mailing address
217 NW 40TH ST, OKLAHOMA CITY, OK 73118-8417
(405) 822-3452
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080969183
—
OK
Enumeration date
08/31/2009
Last updated
07/25/2013
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