Provider Demographics
NPI:1609159383
Name:QUICK, GARY WILLIAM
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WILLIAM
Last Name:QUICK
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 1:4008 S 135TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5612
Mailing Address - Country:US
Mailing Address - Phone:858-829-1690
Mailing Address - Fax:
Practice Address - Street 1:4008 S 135TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-5612
Practice Address - Country:US
Practice Address - Phone:858-829-1690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health