Provider Demographics
NPI:1467400283
Name:GUNTER, JASON STUART (PHD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:STUART
Last Name:GUNTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 SW 119TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4546
Mailing Address - Country:US
Mailing Address - Phone:405-759-3880
Mailing Address - Fax:405-759-3882
Practice Address - Street 1:3224 SW 119TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4548
Practice Address - Country:US
Practice Address - Phone:405-759-3880
Practice Address - Fax:405-759-3882
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1013103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200075170AMedicaid
OK23727800173120A031OtherTRICARE
OK7068560OtherAETNA
OK243605902Medicare ID - Type Unspecified