Provider Demographics
NPI:1467690172
Name:SUTMILLER, GREGORY MICHAEL (LPC, LADC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:SUTMILLER
Suffix:
Gender:M
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6931 S 66TH EAST AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1765
Mailing Address - Country:US
Mailing Address - Phone:918-379-4431
Mailing Address - Fax:918-328-2380
Practice Address - Street 1:6931 S 66TH EAST AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1765
Practice Address - Country:US
Practice Address - Phone:918-379-4431
Practice Address - Fax:918-328-2380
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK4910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor