Provider Demographics
NPI:1467722033
Name:YANDELL, GABRIEL B
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:B
Last Name:YANDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3847 S BOULEVARD STE 400
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5497
Mailing Address - Country:US
Mailing Address - Phone:405-896-5727
Mailing Address - Fax:844-273-8339
Practice Address - Street 1:3847 S BOULEVARD STE 400
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-896-5727
Practice Address - Fax:844-273-8339
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist