Provider Demographics
NPI:1073746327
Name:FINKLEA, GEVON
Entity Type:Individual
Prefix:
First Name:GEVON
Middle Name:
Last Name:FINKLEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E LEE ST
Mailing Address - Street 2:
Mailing Address - City:COYLE
Mailing Address - State:OK
Mailing Address - Zip Code:73027-9200
Mailing Address - Country:US
Mailing Address - Phone:619-957-4050
Mailing Address - Fax:
Practice Address - Street 1:510 E LEE ST
Practice Address - Street 2:
Practice Address - City:COYLE
Practice Address - State:OK
Practice Address - Zip Code:73027-9200
Practice Address - Country:US
Practice Address - Phone:619-957-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS081739743Medicaid