Healthcare Provider Details

I. General information

NPI: 1285146688
Provider Name (Legal Business Name): GWENDOLYN IRENE HARDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 E ROSS AVE
SAPULPA OK
74066-6423
US

IV. Provider business mailing address

1506 E NEW ORLEANS PL
BROKEN ARROW OK
74011-5139
US

V. Phone/Fax

Practice location:
  • Phone: 918-227-2016
  • Fax:
Mailing address:
  • Phone: 918-361-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12759
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: