Basic Information
| Provider Information | |||||||||
| NPI: | 1053428904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GURULE' | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1904 E 73RD ST | ||||||||
| Address2: | APT. 17-C | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741367478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188144726 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5525 E 51ST ST | ||||||||
| Address2: | SUITE #400 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741357461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187120859 | ||||||||
| FaxNumber: | 9183886456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.