Individual
MR. GARY M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
304 W WILL ROGERS BLVD, CLAREMORE, OK 74017-7022
(918) 343-3456
Mailing address
304 W WILL ROGERS BLVD, CLAREMORE, OK 74017-7022
(918) 343-3456
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1175
OK
Other
Enumeration date
09/23/2005
Last updated
02/22/2012
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