Healthcare Provider Details

I. General information

NPI: 1295168706
Provider Name (Legal Business Name): LERON GREGORY WEST MHR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W TECUMSEH ST
TULSA OK
74127-2506
US

IV. Provider business mailing address

PO BOX 27762
TULSA OK
74149-0762
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-7280
  • Fax: 918-582-7612
Mailing address:
  • Phone: 918-269-3013
  • Fax: 918-582-7612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: