=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609054576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARY L JONES PHD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2008
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6846 S CANTON AVE STE 140
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 539-867-2820
-----------------------------------------------------
Fax | 877-811-5836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6846 S CANTON AVE STE 140
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 539-867-2820
-----------------------------------------------------
Fax | 877-811-5836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | GARY L JONES
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 539-867-2820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------