Healthcare Provider Details

I. General information

NPI: 1487879136
Provider Name (Legal Business Name): THANGKHAN K GUALNAM LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 E 81ST ST STE 4460
TULSA OK
74137-4251
US

IV. Provider business mailing address

2448 E 81ST ST STE 4460
TULSA OK
74137-4251
US

V. Phone/Fax

Practice location:
  • Phone: 918-600-2966
  • Fax:
Mailing address:
  • Phone: 918-600-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4046
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: