Provider Demographics
NPI:1699019349
Name:GASTON, ERMA WILLETLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ERMA
Middle Name:WILLETLE
Last Name:GASTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:ERMA
Other - Middle Name:WILLETLE
Other - Last Name:SIMMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 NE 48TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-6203
Mailing Address - Country:US
Mailing Address - Phone:405-816-9213
Mailing Address - Fax:405-525-7003
Practice Address - Street 1:3925 N LINCOLN BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5225
Practice Address - Country:US
Practice Address - Phone:405-525-7000
Practice Address - Fax:405-525-7003
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst