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General NPI Number Information
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NPI Number | 1861686271
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Entity Type | Organization
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Legal Business Name | GARY CONE CORP.
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 1916 N DREXEL BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73107-3925
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Country | US
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Telephone | 405-942-3935
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60106
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City | OKLAHOMA CITY
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State | OK
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Zip | 73146-0106
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Country | US
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Telephone | 405-942-3935
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARY LYNN CONE
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Credential | PH.D.
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Telephone | 405-942-3935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 59
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License Number State | OK
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