Provider Demographics
NPI:1740417179
Name:GILLEY, CURTIS G (LBP)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:G
Last Name:GILLEY
Suffix:
Gender:M
Credentials:LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PAM DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3313
Mailing Address - Country:US
Mailing Address - Phone:405-990-2846
Mailing Address - Fax:405-275-4717
Practice Address - Street 1:41 PAM DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3313
Practice Address - Country:US
Practice Address - Phone:405-990-2846
Practice Address - Fax:405-275-4717
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0248103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling