Provider Demographics
NPI:1770087439
Name:GATESWAY FOUNDATION INC
Entity type:Organization
Organization Name:GATESWAY FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-259-1404
Mailing Address - Street 1:1217 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4204
Mailing Address - Country:US
Mailing Address - Phone:918-249-1404
Mailing Address - Fax:
Practice Address - Street 1:1217 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4204
Practice Address - Country:US
Practice Address - Phone:918-249-1404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATESWAY FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty