| Doctor Name: | MR. MARK I GOMEZ |
| NPI Number: | 1265733539 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 105365 Highway102 Mcloud, OK - 74851 |
| Business Phone Number: | 4059642081 |
| Business Fax Number: | |
| Mailing Address: | 1117 Straka Ter, OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731392518 |
| Phone Number: | 9183609926 |
| Fax Number: | |
| NPI Enumeration Date: | 11/03/2010 |
| NPI Last Update Date: | 01/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |