MEDICARE: ANTONETTE GULLY BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-24-78685	OK

General Provider Information

NPI Number	:	1396378758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONETTE GULLY BCBA, LBA

Provider Business Mailing Address
First Line	:	3635 NW 39TH EXPRESSWAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6309
Country	:	US
Telephone Number	:	405-857-8280
Fax Number	:

Provider Business Practice Location Address
First Line	:	3635 NW 39TH EXPRESSWAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6309
Country	:	US
Telephone Number	:	405-857-8280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	01/26/2026

Similar Medicare Providers

1942907613 — SHELBY THOMPSON BCBA
Practice Location Address:

3635 NW 39TH EXPRESSWAY
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-857-8280
Practice Fax:

1235169129 — CHILDREN'S DENTAL CLINIC OF OKLAHOMA CITY AT PORTLAND PLAZA, PLLC
Practice Location Address:

3637 NW 39TH ST
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-942-7755
Practice Fax:

1578656393 — MARK T KELLY
Practice Location Address:

3637 NW 39TH ST
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-942-7755
Practice Fax:

1225260151 — DR. BRANDON ROBERT MAYES O.D.
Practice Location Address:

3631 NW 39TH ST
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-943-2020
Practice Fax:

1336662790 — BRYCE MAYES OD
Practice Location Address:

3637 NW 39TH ST
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-943-2020
Practice Fax:

1356969141 — LEVI QUANGLONG PHAM
Practice Location Address:

3625 NW 39TH ST
OKLAHOMA CITY, OK
73112-6309

Practice Phone: 405-253-0107
Practice Fax:

Directions to “ ANTONETTE GULLY BCBA, LBA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.