Provider Demographics
NPI:1659706075
Name:BACKER, GAYE LABETH (LPC)
Entity type:Individual
Prefix:MRS
First Name:GAYE
Middle Name:LABETH
Last Name:BACKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:OK
Mailing Address - Zip Code:73028-0068
Mailing Address - Country:US
Mailing Address - Phone:405-823-5314
Mailing Address - Fax:
Practice Address - Street 1:106 S GRAND ST
Practice Address - Street 2:
Practice Address - City:CRESCENT
Practice Address - State:OK
Practice Address - Zip Code:73028-0068
Practice Address - Country:US
Practice Address - Phone:405-823-5314
Practice Address - Fax:405-969-3887
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK160531101YS0200X
OK5714101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200509560BMedicaid