Healthcare Provider Details

I. General information

NPI: 1659706075
Provider Name (Legal Business Name): GAYE LABETH BACKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 11/20/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S GRAND ST
CRESCENT OK
73028-0068
US

IV. Provider business mailing address

PO BOX 68
CRESCENT OK
73028-0068
US

V. Phone/Fax

Practice location:
  • Phone: 405-823-5314
  • Fax: 405-969-3887
Mailing address:
  • Phone: 405-823-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5714
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number160531
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: