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General NPI Number Information
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NPI Number | 1326569252
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Entity Type | Organization
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Legal Business Name | GILEAD COUNSELING CENTER LLC
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2448 E 81ST ST STE 2045
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City | TULSA
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State | OK
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Zip | 74137-4271
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Country | US
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Telephone | 918-388-7017
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Fax |
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Provider Business Mailing Address
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Address Line | 2448 E 81ST ST STE 2045
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City | TULSA
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State | OK
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Zip | 74137-4271
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Country | US
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Telephone | 918-388-7017
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. THANGKHAN KHAM GUALNAM
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Credential | M.A., LPC
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Telephone | 918-388-7017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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