Individual
RUSSELL O GILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LADC
Contact information
Practice address
1008 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4734
(918) 458-0113
(918) 458-0075
Mailing address
112 W MAIN ST, PURCELL, OK 73080-4220
(405) 527-1785
(405) 527-1084
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
271
OK
101YP2500X
Professional Counselor
Primary
2303
OK
Other
Enumeration date
11/23/2010
Last updated
11/23/2010
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