Organization
COMMUNITY RESOURCE PROFESSIONALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY WILSON LCSW, LADC (CLINICAL SOCIAL WORKER)
(918) 343-3456
Entity
Organization
Contact information
Practice address
304 W WILL ROGERS BLVD, CLAREMORE, OK 74017-7022
(918) 343-3456
(918) 343-3456
Mailing address
304 W WILL ROGERS BLVD, CLAREMORE, OK 74017-7022
(918) 343-3456
(918) 343-3456
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1175
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1175
SOCIAL WORK LICENSE
OK
01
—
562
LADC LICENSE NUMBER
OK
Enumeration date
04/10/2007
Last updated
09/10/2009
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