Provider Demographics
NPI:1689921702
Name:GUNTER, ODELL V
Entity Type:Individual
Prefix:MR
First Name:ODELL
Middle Name:V
Last Name:GUNTER
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 1:4827 NW HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-1630
Mailing Address - Country:US
Mailing Address - Phone:580-298-3001
Mailing Address - Fax:580-298-5357
Practice Address - Street 1:903 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2045
Practice Address - Country:US
Practice Address - Phone:580-298-3001
Practice Address - Fax:580-298-5357
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation