MEDICARE: KAREN LORELLE GILLS BHRS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1063761633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LORELLE GILLS BHRS

Provider Business Mailing Address
First Line	:	411 EAST OKLAHOMA STREET
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106
Country	:	US
Telephone Number	:	918-855-7456
Fax Number	:	918-340-5189

Provider Business Practice Location Address
First Line	:	4528 SOUTH SHERIDAN ROAD
Second Line	:	SUITE 117
City	:	TULSA
State	:	OK
Zip	:	74145-1140
Country	:	US
Telephone Number	:	918-794-6570
Fax Number	:	918-340-5189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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