Provider Demographics
NPI:1356575450
Name:GATES, STEVEN WAYNE (MBS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:WAYNE
Last Name:GATES
Suffix:
Gender:M
Credentials:MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 116
Mailing Address - Street 2:
Mailing Address - City:LAVERNE
Mailing Address - State:OK
Mailing Address - Zip Code:73848-9435
Mailing Address - Country:US
Mailing Address - Phone:580-735-2831
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 116
Practice Address - Street 2:
Practice Address - City:LAVERNE
Practice Address - State:OK
Practice Address - Zip Code:73848-9435
Practice Address - Country:US
Practice Address - Phone:580-735-2831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health