Provider Demographics
NPI:1578816989
Name:GALLUP, DONALD COLE (MS)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:COLE
Last Name:GALLUP
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15867 COUNTY ROAD 3619 LOOP
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1443
Mailing Address - Country:US
Mailing Address - Phone:580-235-0203
Mailing Address - Fax:
Practice Address - Street 1:15867 COUNTY ROAD 3619 LOOP
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1443
Practice Address - Country:US
Practice Address - Phone:580-235-0203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health