| Doctor Name: | GWENDA LEE ROBERTS |
| NPI Number: | 1467882985 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 3508 Maloney Dr Oklahoma, OKLAHOMA - 73121 |
| Business Phone Number: | 4054376381 |
| Business Fax Number: | |
| Mailing Address: | 3508 Maloney Dr, OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731216656 |
| Phone Number: | 4054276381 |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2013 |
| NPI Last Update Date: | 11/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP1600X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Pastoral |
| Taxonomy Definition: | |