Provider Demographics
NPI:1669787768
Name:ANTOINE, GUY LOUISE
Entity type:Individual
Prefix:MISS
First Name:GUY
Middle Name:LOUISE
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:ANTOINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 W OHIO
Mailing Address - Street 2:P.O. BOX # 284
Mailing Address - City:KIEFER
Mailing Address - State:OK
Mailing Address - Zip Code:74041-4523
Mailing Address - Country:US
Mailing Address - Phone:918-812-2072
Mailing Address - Fax:
Practice Address - Street 1:1516 S BOSTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4003
Practice Address - Country:US
Practice Address - Phone:918-561-6000
Practice Address - Fax:918-561-6001
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist