Basic Information
| Provider Information | |||||||||
| NPI: | 1144604612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | OLGA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 B ST APT 26 | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748202879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059057535 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 SW 10TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731095610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052360701 | ||||||||
| FaxNumber: | 4052360737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2015 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.