Provider Demographics
NPI:1750719886
Name:MARYLEE GASKINS
Entity type:Organization
Organization Name:MARYLEE GASKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:
Authorized Official - First Name:MARYLEE
Authorized Official - Middle Name:NANNELL
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-272-5326
Mailing Address - Street 1:302 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4612
Mailing Address - Country:US
Mailing Address - Phone:918-272-5326
Mailing Address - Fax:
Practice Address - Street 1:302 E 19TH ST
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4612
Practice Address - Country:US
Practice Address - Phone:918-272-5326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Single Specialty