Provider Demographics
NPI:1730470725
Name:GILSTRAP, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:GILSTRAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40178 S CR 4550 RD.
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:OK
Mailing Address - Zip Code:74941-6483
Mailing Address - Country:US
Mailing Address - Phone:918-966-3731
Mailing Address - Fax:
Practice Address - Street 1:40178 S CR 4550 RD.
Practice Address - Street 2:
Practice Address - City:KEOTA
Practice Address - State:OK
Practice Address - Zip Code:74941-6483
Practice Address - Country:US
Practice Address - Phone:918-966-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor