Basic Information
| Provider Information | |||||||||
| NPI: | 1689820649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GATES | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | BESS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LADC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GATES | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | BESS | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LADC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3015 E SKELLY DR | ||||||||
| Address2: | 270 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741056317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188327763 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3015 E SKELLY DR | ||||||||
| Address2: | 270 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741056317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188327763 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2008 | ||||||||
| LastUpdateDate: | 08/11/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 517 | OK | Y | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 517 | OK | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.