Healthcare Provider Details

I. General information

NPI: 1467400283
Provider Name (Legal Business Name): JASON STUART GUNTER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 SW 119TH ST
OKLAHOMA CITY OK
73170-4548
US

IV. Provider business mailing address

3224 SW 119TH ST STE A
OKLAHOMA CITY OK
73170-4546
US

V. Phone/Fax

Practice location:
  • Phone: 405-759-3880
  • Fax: 405-759-3882
Mailing address:
  • Phone: 405-759-3880
  • Fax: 405-759-3882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1013
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: