Provider Demographics
NPI:1760728919
Name:GULLEY, CHARLYNNE ANDRENITA
Entity Type:Individual
Prefix:MISS
First Name:CHARLYNNE
Middle Name:ANDRENITA
Last Name:GULLEY
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 1:6219 S INDEPENDENCE AVE
Mailing Address - Street 2:APT. 120
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-1216
Mailing Address - Country:US
Mailing Address - Phone:405-410-5801
Mailing Address - Fax:
Practice Address - Street 1:6219 S INDEPENDENCE AVE
Practice Address - Street 2:APT. 120
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-1216
Practice Address - Country:US
Practice Address - Phone:405-410-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst