Doctor Name: | MR. GERALD WAYNE ATCHLEY |
NPI Number: | 1023212370 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MHR, LPC |
License Number: | 2622 |
Business Practice Address: | 20866 W. 71 St Sand Springs, OK - 74063 |
Business Phone Number: | 9186374389 |
Business Fax Number: | |
Mailing Address: | 20866 W. 71 St, SAND SPRINGS |
State: | OK |
Postal Code: | 74063 |
Phone Number: | 9186374389 |
Fax Number: | |
NPI Enumeration Date: | 06/12/2007 |
NPI Last Update Date: | 06/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2622 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |