Healthcare Provider Details

I. General information

NPI: 1639084981
Provider Name (Legal Business Name): GUSSY ELVIK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W EUFAULA ST STE 213
NORMAN OK
73069-5656
US

IV. Provider business mailing address

102 W EUFAULA ST STE 213
NORMAN OK
73069-5656
US

V. Phone/Fax

Practice location:
  • Phone: 405-996-8588
  • Fax:
Mailing address:
  • Phone: 405-996-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AUGUSTA ANNE ELVIK
Title or Position: LPC-S,RPT
Credential:
Phone: 405-996-8588