Provider Demographics
NPI:1669536694
Name:GILBERT, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 N SHARTEL AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-1036
Mailing Address - Country:US
Mailing Address - Phone:405-606-8406
Mailing Address - Fax:405-606-8194
Practice Address - Street 1:3700 N CLASSEN BLVD STE 240
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2860
Practice Address - Country:US
Practice Address - Phone:405-606-8406
Practice Address - Fax:405-606-8194
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKT082962321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist