Provider Demographics
NPI:1316374309
Name:SINNES, GARY LEE (LADC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:SINNES
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8124 E INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-6816
Mailing Address - Country:US
Mailing Address - Phone:405-334-1571
Mailing Address - Fax:
Practice Address - Street 1:8124 E INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6816
Practice Address - Country:US
Practice Address - Phone:405-334-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK496101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)