Provider Demographics
NPI:1790061273
Name:VANGALDER, ROBERT MARTIN II
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MARTIN
Last Name:VANGALDER
Suffix:II
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 1:1901 S 68TH EAST AVE APT 220B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-7649
Mailing Address - Country:US
Mailing Address - Phone:918-955-9436
Mailing Address - Fax:
Practice Address - Street 1:1901 S 68TH EAST AVE APT 220B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-7649
Practice Address - Country:US
Practice Address - Phone:918-955-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor