Provider Demographics
NPI:1083995252
Name:GAY, DIANA MICHELLE (BHRS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MICHELLE
Last Name:GAY
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N CLARENCE NASH BLVD
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-3636
Mailing Address - Country:US
Mailing Address - Phone:405-275-4291
Mailing Address - Fax:405-275-4291
Practice Address - Street 1:1407 SHERRY LN
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-5421
Practice Address - Country:US
Practice Address - Phone:405-275-4291
Practice Address - Fax:405-275-4291
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor