Provider Demographics
NPI:1467485557
Name:WISOR, GAYLA J (MS)
Entity Type:Individual
Prefix:
First Name:GAYLA
Middle Name:J
Last Name:WISOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:GAYLA
Other - Middle Name:J
Other - Last Name:EASTEP-BIRCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:33432 N COUNTY ROAD 3130
Mailing Address - Street 2:
Mailing Address - City:ELMORE CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73433-8716
Mailing Address - Country:US
Mailing Address - Phone:843-655-1740
Mailing Address - Fax:
Practice Address - Street 1:902 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6605
Practice Address - Country:US
Practice Address - Phone:405-527-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional