Provider Demographics
NPI:1922553304
Name:GAMMILL, MACKEY ANDREWS
Entity Type:Individual
Prefix:
First Name:MACKEY
Middle Name:ANDREWS
Last Name:GAMMILL
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 1:32997 N COUNTY ROAD 3250
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:OK
Mailing Address - Zip Code:73030-9226
Mailing Address - Country:US
Mailing Address - Phone:580-369-8570
Mailing Address - Fax:
Practice Address - Street 1:15 MONROE ST NE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2025
Practice Address - Country:US
Practice Address - Phone:580-226-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7784101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program