Provider Demographics
NPI:1417486077
Name:EMORY, GABRIELLE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:
Last Name:EMORY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4867 S SHERIDAN RD STE 712E
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5721
Mailing Address - Country:US
Mailing Address - Phone:918-520-3199
Mailing Address - Fax:
Practice Address - Street 1:4867 S SHERIDAN RD STE 712E
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5721
Practice Address - Country:US
Practice Address - Phone:918-520-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKE082989513101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor