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General NPI Number Information
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NPI Number | 1457638504
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Entity Type | Individual
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Provider Name | ELENA MARIE GORE B.S.
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Gender | Female
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 6126 E 32ND PL
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City | TULSA
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State | OK
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Zip | 74135-5406
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Country | US
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Telephone | 918-394-2256
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Fax |
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Provider Business Mailing Address
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Address Line | 4117 S 39TH WEST AVE
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City | TULSA
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State | OK
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Zip | 74107-6343
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Country | US
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Telephone | 918-633-6339
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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