Provider Demographics
NPI:1841386679
Name:JONES, GARY LEE (PHD)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 S HARVARD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2908
Mailing Address - Country:US
Mailing Address - Phone:918-747-5565
Mailing Address - Fax:918-747-5568
Practice Address - Street 1:4612 S HARVARD AVE
Practice Address - Street 2:STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2908
Practice Address - Country:US
Practice Address - Phone:918-747-5565
Practice Address - Fax:918-747-5568
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100838650AMedicaid
OK100838650AMedicaid