MEDICARE: GARY CONE CORP.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	59	OK

General Provider Information

NPI Number	:	1861686271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY CONE CORP.

Provider Business Mailing Address
First Line	:	PO BOX 60106
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73146-0106
Country	:	US
Telephone Number	:	405-942-3935
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 N DREXEL BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-3925
Country	:	US
Telephone Number	:	405-942-3935
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GARY LYNN CONE
Credential	:	PH.D.
Telephone Number	:	405-942-3935

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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Directions to “GARY CONE CORP. ” Practice Location

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