Individual
MR. GORDON RAY WHITEWOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LBP
Contact information
Practice address
101 RIVERSIDE DRIVE, RIVERSIDE INDIAN SCHOOL, ANADARKO, OK 73005
(405) 247-6670
(405) 247-2029
Mailing address
101RIVERSIDE DRIVE, ANADARKO, OK 73005
(405) 247-6670
(405) 247-2029
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
386
OK
101YM0800X
Mental Health Counselor
Primary
0216
OK
Other
Enumeration date
12/01/2008
Last updated
12/01/2008
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