Individual
JUANITA GATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 E ST, WEWOKA, OK 74884-6600
(405) 658-8051
Mailing address
101 E ST, WEWOKA, OK 74884-6600
(405) 380-3039
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D082460821
DL
OK
05
—
D082460821
—
OK
Enumeration date
06/27/2019
Last updated
06/27/2019
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