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General NPI Number Information
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NPI Number | 1225582638
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Entity Type | Organization
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Legal Business Name | GORGES INC
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 1218 E 9TH ST STE 4
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City | EDMOND
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State | OK
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Zip | 73034-5796
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Country | US
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Telephone | 405-949-5004
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Fax | 405-563-9479
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Provider Business Mailing Address
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Address Line | 1218 E 9TH ST STE 4
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City | EDMOND
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State | OK
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Zip | 73034-5796
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Country | US
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Telephone | 405-949-5004
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Fax | 405-563-9479
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ANNE AMREIN
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Credential | LPC
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Telephone | 405-254-6055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4948
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License Number State | OK
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