Provider Demographics
NPI:1366565905
Name:CHANEY, GWYNETTE MARIA (MS MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:GWYNETTE
Middle Name:MARIA
Last Name:CHANEY
Suffix:
Gender:F
Credentials:MS MED, LPC
Other - Prefix:
Other - First Name:GWYNETTE
Other - Middle Name:MARIA
Other - Last Name:CHANEY OLDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:124 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-4204
Mailing Address - Country:US
Mailing Address - Phone:918-604-6054
Mailing Address - Fax:918-777-9018
Practice Address - Street 1:124 E 6TH ST
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-4204
Practice Address - Country:US
Practice Address - Phone:918-604-6054
Practice Address - Fax:918-777-9018
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK6487101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor