Provider Demographics
NPI:1952510695
Name:KINDER, GERALD WILLIAM (DMIN)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WILLIAM
Last Name:KINDER
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1739
Mailing Address - Country:US
Mailing Address - Phone:918-664-9370
Mailing Address - Fax:918-610-8517
Practice Address - Street 1:8920 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1739
Practice Address - Country:US
Practice Address - Phone:918-664-9370
Practice Address - Fax:918-610-8517
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK550106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist