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General NPI Number Information
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NPI Number | 1245646389
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Entity Type | Individual
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Provider Name | LISA DANIELLE GALE PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 4612 S HARVARD AVE STE A
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City | TULSA
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State | OK
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Zip | 74135-2908
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Country | US
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Telephone | 918-747-5565
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Fax | 918-560-1399
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Provider Business Mailing Address
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Address Line | 4612 S HARVARD AVE STE A
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City | TULSA
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State | OK
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Zip | 74135-2908
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Country | US
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Telephone | 918-747-5565
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Fax | 918-747-5568
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 18797
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 120851
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License Number State | OK
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