Individual
ANTHONY JEROME GILLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2424 N KEY BLVD, MIDWEST CITY, OK 73110-4662
(405) 413-1555
Mailing address
PO BOX 15722, OKLAHOMA CITY, OK 73155-5722
(405) 413-1555
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
J081668277
OK
104100000X
Social Worker
J081668277
OK
Other
Enumeration date
02/07/2014
Last updated
02/07/2014
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