Provider Demographics
NPI:1790969004
Name:MCGILL, POMMETHA (BA)
Entity Type:Individual
Prefix:MS
First Name:POMMETHA
Middle Name:
Last Name:MCGILL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7747 S VICTOR AVE
Mailing Address - Street 2:24D
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7724
Mailing Address - Country:US
Mailing Address - Phone:918-794-4457
Mailing Address - Fax:
Practice Address - Street 1:7010 S YALE AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5713
Practice Address - Country:US
Practice Address - Phone:918-492-2554
Practice Address - Fax:918-499-1598
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent