Healthcare Provider Details

I. General information

NPI: 1285213348
Provider Name (Legal Business Name): ANNORA ELISE GILLISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N GREENWOOD AVE STE 131
TULSA OK
74120-1444
US

IV. Provider business mailing address

101 N GREENWOOD AVE STE 131
TULSA OK
74120-1444
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-7277
  • Fax: 919-599-7716
Mailing address:
  • Phone: 918-599-7277
  • 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:
Title or Position:
Credential:
Phone: