| Doctor Name: | MR. GORDON RAY WHITEWOLF |
| NPI Number: | 1891940045 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LBP |
| License Number: | 386 |
| Business Practice Address: | 101 Riverside Drive Riverside Indian School Anadarko, OK - 73005 |
| Business Phone Number: | 4052476670 |
| Business Fax Number: | 4052472029 |
| Mailing Address: | 101riverside Drive, ANADARKO |
| State: | OK |
| Postal Code: | 73005 |
| Phone Number: | 4052476670 |
| Fax Number: | 4052472029 |
| NPI Enumeration Date: | 12/01/2008 |
| NPI Last Update Date: | 12/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 386 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |