| Gravel Road Mental Health Services, Pllc | |
|
9905 S Pennsylvania Ave Ste A Oklahoma City OK 73159-6920 | |
| (405) 394-5298 | |
| Not Available |
| Full Name | Gravel Road Mental Health Services, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 9905 S Pennsylvania Ave Ste A, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Cari Gravel (MEMBER) |
| Authorized Official Contact | 4053945298 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gravel Road Mental Health Services, Pllc Po Box 904 Maud OK 74854-0904 Ph: (405) 394-5298 | Gravel Road Mental Health Services, Pllc 9905 S Pennsylvania Ave Ste A Oklahoma City OK 73159-6920 Ph: (405) 394-5298 |
| NPI Number | 1174260434 |
|---|---|
| Provider Enumeration Date | 05/18/2022 |
| Last Update Date | 08/18/2022 |
| Certification Date | 08/18/2022 |
| Medicare PECOS PAC ID | 1759765449 |
|---|---|
| Medicare Enrollment ID | O20220830000792 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174260434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Cari Gravel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376061127 PECOS PAC ID: 3779908942 Enrollment ID: I20200805000533 |
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